| Background and Objective: Helicobacter pylori (Helicobacter pylori Hp) has a veryclose contact with a variety of upper gastrointestinal diseases,and is a risk factor for pepticulcer and chronic gastritis, Helicobacter pylori is closely related with non-ulcer dyspepsia、gastric cancer and gastric mucosalymphoid tissue lymphoma’s the occurrence anddevelopment, in1994the world Health Organization as a class Ⅰ carcinogen.Helicobacter pylori is a common chronic infection, more than half of the people worldwideinfect with it, our areas are high infection, the average infection rate is59%, and there areregional differences. Consensus conference worked out in line with China’s actual infectionin the first-line, second line, and remedial treatment of a variety of programs in China afterthe three national Helicobacter pylori infection in clinical practice and made remarkableachievements, but because in recent years of clinical use of antibiotics is not normative leadto Hp resistance to antibiotics increasing, the inappropriate treatment of Hp infection inpatients unable to be effective in eradicating Hp eradication, and now clinical treatmentfailure cases gradually is increasing. Therefore, the losers in the selection of remedialtreatment program for Hp eradication is particularly important. This study through theevaluation of the initial eradication of Hp failure of chronic gastritis and peptic ulcer patientsthe efficacy of remedial treatment programs for sequential therapy and quadruple therapy inthe eradication rate, the incidence of adverse reactions, the remission rate and cost-effectiveness to compare to seek an efficient, economical, safe, convenient remedialtreatment program.Subjects and methods: Due to abdominal pain, acid reflux, heartburn, bloating andother abdominal discomfort symptoms treatment and digest the internal medicine outpatientand inpatient department for the first time186cases of eradication failure patients wererandomly divided intoquadruple sequential treatment group and standard control groupaccording to treatment sequence and the presence of allergic reactions to penicillin.Containing amoxicillin sequential treatment groups: the first5days of Rabeprazole the azole10mg+amoxicillin1000mg+furazolidone100mg twice daily oral; after5days ofRabeprazole10mg+amoxicillin1000mg+levofloxacin200mg twice daily oral treatment of a total of10days. Quadruple in the control group with amoxicillin standards: Rabeprazole10mg+amoxicillin1000mg+levofloxacin200mg,2times a day oral colloidal bismuthpectin200mg,3times a day oral treatment14days. Without amoxicillin sequentialtreatment groups: the first5days of Rabeprazole10mg+levofloxacin200mg+furazolidone100mg,2times a day oral administration of5days after Rabeprazole the azole10mg+levofloxacin200mg+clarithromycin500mg,2times a day orally, were treated for10days.Amoxicillin standard quadruple-free control group: Rabeprazole10mg+left Ofloxacin200mg+furazolidone100mg,2times a day orally, colloidal bismuth pectin200mg,3timesa day oral,treatment14days. The end of the course of treatment discontinuation at least fourweeks after the review of the14C urea breath test, were negative for Hp eradication, theresults positive, compared with eradication failure. Comparison of two groups of patientswith adverse drug reactions in the process of eradication, improvement of symptoms, theeradication rate and cost-effectiveness. The SPSS17.O software for statistical analysis, therate expressed as a percentage and compared using the χ2test, P <0.05was consideredstatistically significant difference.Result: Eradication rate, according to the ITT and PP analysis: sequential therapygroup with amoxicillin eradication rates were79.55%and85.37%; containing amoxicillingroup standard quadruple control group eradication rates were75.56%and82.93%;containing amoxicillin sequential treatment group eradication rates were72.34%and79.07%; excluding amoxicillin standard quadruple control group eradication rates were68%and77.27%, the sequential therapy group eradication rates were75.82%and82.14%,total eradication rate of quadruple therapy in the control group eradication rates71.58%and80%respectively. Remission rates compared with amoxicillin sequential treatment groupremission rate was84.1%; containing amoxicillin group standard quadruple control groupremission rate was82.22%; the sequential treatment group excluding amoxicillin remissionrate was82.98%; without amoxicillin standard quadruple control group remission rate was80%.Total remission rate was83.52%in the sequential therapy group, the total remissionrate was81.44%in the quadruple therapy in the control group. Containing amoxicillinsequential treatment group containing amoxicillin quadruple the control group, thesequential treatment group, excluding amoxicillin without amoxicillin standard quadruplethe control group, with amoxicillin sequential treatment group, with and withouttheamoxicillin sequential treatment group, including amoxicillin quadruple the control groupwith and without amoxicillin standard quadruple the control group, the sequential treatment group and the standard quadruple the control group, the HP eradication rate, remission rateshowed no significantdifference (P>0.05). Incidence of adverse reactions, adverse reactionswith amoxicillin sequential treatment group disease rate was11.36%; containing amoxicillingroup standard quadruple control group of adverse reactions was22.22%; sequentialtreatment group, excluding amoxicillinadverse reaction rate was10.63%; withoutamoxicillin standard quadruple control group of adverse reactions was28%, the sequentialtherapy group total adverse reaction rate was10.99%, and quadruple therapy in the controlgroup the total incidence of adverse reactions rate was25.26%; With amoxicillin insequential group containing the amoxicillin group, including amoxicillin sequential groupwith and without amoxicillin sequential group containing amoxicillin joint group with andwithout amoxicillin standard quadruple groupincidence of adverse reactions showed nosignificant differences (P>0.05); non-sequential group of amoxicillin with and withoutamoxicillin standard quadruple group, the sequential therapy group and the standardquadruple group, incidence of adverse reactions comparedthere are significant differences (P<0.05).Different disease eradication rate:compared to the group of peptic ulcer patients witheradication rates of eradication rate compared to the same group of chronic patients with gastric is root,but there was no significant difference (P>0.05), with amoxicillin sequential treatment group containingAMo Xilin quadruple the control group, the sequential treatment group, excluding amoxicillin withoutamoxicillin standard quadruple the control group, with of amoxicillin sequential treatment group, withand without amoxicillin sequential treatment group, with amoxicillinthe Xilin quadruple control groupwith and without amoxicillin standard quadruple the control group, the sequential treatment group andthe standard quadruple control group of chronic gastritis and peptic ulcer patients with eradication rateswere not significantly different (P>0.05). Cost-effectiveness analysis: sequential compositioncontaining amoxicillin:414.31yuan, including amoxicillin quadruple comprising the:691.74yuan, excluding amoxicillin sequential composition:493.86yuan, excluding amoxicillinstandard quadruplecomposition:641.33yuan; containing amoxicillin sequential group C/E,minimum.Conclusion:1.10days of sequential therapy and14days of quadruple therapy in theremedial treatment HP eradication effect, relief of symptoms regard to efficacy similar.2with amoxicillin remedial treatment program and remedial treatment program withoutamoxicillin HP eradication effect similar.3.10days of sequential therapy compared with14days of quadruple therapy in the remedial treatment of adverse events is low, cost-effectiveness than low.4Peptic ulcer and chronic gastritis patients have a similar effect of HP eradication.5.10days of sequential therapy compared with14days of quadruple therapyfor HP eradication in the remedial treatment effect similar incidence of adverse reactions islow, short treatment time, costs-better than the proposals would be sequential therapy asfirst-line salvage therapy program. |
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