Efficacy Of Helicobacter Pylori Infection In The Initial Treatment Of Three Programs

1.Background:China is a developing country,and H.pylori infection rate is high.Its infection not only connecetd in the upper gastrointestinal diseases,but also associated with certain parenteral diseases.The World Health Organization has H.pylori as gastric I carcinogenic factor,so H.pylori infection treatment is a key topic in H.pylori research.But there are many problems in the treatment of H.pylori.Now to eradicate H.pylori remains difficult.The main cause of failure is H.pylori resistant to antibiotics,so that the eradication rate of H.pylori becomes lower.In order to improve the H.pylori eradication rate,someone recommends a number of eradication programs in recent years in the world,including sequential therapy,concomitant therapy and Levofloxacin combined therapy.In multicenter randomized controlled study in China,sequential therapy compared with standard triple therapy displys no advantage. The purpose of this study was tocompare the eradication rates of H.pylori with bismuth-containing quadruple therapy,clarithromycin-containing triple therapy and furazolidone-containing triple therapy,and select an effective,safe,convienient and economical treatment.2.Method: From November 2013 to October 2014 at Tianjin Port hospital 212 patients diagnosed by 14C-UBT for detection of H.pylori infection were randomized intothree groups.Group A(n=72):Application of esomeprazole(20mg bid)+amoxicillin(1000mg bid)+ clarithromycin(500mg bid)+Colloidal Bismuth Subcitrate(220mg bid),for 10day;Group B(n=71):Application of esomeprazole(20mg bid)+amoxicillin(1000mg bid)+ clarithromycin(500mg bid),for 10day;Group C:Application of esomeprazole(20mg bid)+amoxicillin(1000mg bid)+ urazolidone(100mg bid),for 10 day.Stopped drugs after 4 weeks and 14C-UBT was used to detect and compare Helicobacter pylori eradication rates in the all groups.3. Result Comparison of different groups on the eradication rate:202 patients completed their treatments and follow-ups,10 cases unfinished.As for ITT analyses,the rates of H.Pylori eradication in group A,B and C are 83.3%,67.6%,82.6%,and there were significant differences in eradication rates of three groups(P?0.05).Group A and B, B and C eradication rate has statistically difference(p ? 0.05).There was no differencein eradication rate between group A and C.As for PP analyses,the rates of H.pylori eradication in group A,B and C are 87.0%,69.6%,89.1%,and there were significant differences in eradication rates of three groups(P?0.05).Group A and B,B and C on the eradication rates has statistically difference(P?0.05).There was no differencein eradication rate between group A and C(P>0.05).Adverse drug reactions: The adverse reactions rates of the three groups were14.5%,11.6% and 10.9%.The difference had not statistical significance(P>0.05).Comparison among three different treatment costs: group A 403.7 yuan,group B 370.9yuan, and group C 289.1yuan. Cost effect analysis shows that group C has the lowest cost per unit effect.4.Conclusion:bismuth-containing quadruple therapy and furazolidone-containing triple therapy are more effective than clarithromycin-containing triple therapy to eradicate H.Pylori, but furazolidone-containing triple therapy has the lowest cost per unit effect,so in clinical work in this area,furazolidone-containing triple therapy for 10 days can be used as the principle option of empirical treatments for H.pylori infection.