مقايسه رژيم هاي درماني سه دارويي، چهاردارويي و دو روش مختلف Sequential در درمان خط اول عفونت هليكوباكترپيلوري

Comparison Of Triple, Quadruple and Two Sequential Drug Therapy for Eradication of Helicobacter Pylori Infection

Background and objective: Numerous regimens of several antimicrobial agents are suggested for eradication of H.pylori infection . Resistance to antibacterial agents is common in H.pylori Strains in developing countries such as our country. Thus its eradication is an important issue. The aim of present study was to compare the triple, quadruple and sequential therapy regimens for eradication of H.pylori infection and achieve to most effective regimen for first line eradication therapy of H.pylori infection in our country. Materials and methods: We conducted a prospective randomized trial of 428 patients with peptic ulcer and Helicobacter Pylori infection from 2007 to 2008. Recruited patients were randomized into four equal groups (each groups contains 107 patients) for eradication regimens: Group A: Omeprazole 40mg b.d, amoxicillin lg bid metronidazol 500mg b.d bismuth subcitrate 120mg q.d, for two weeks. Group B: Omeperazole 20mg b.d Amoxicillin lgr b.d. clathromycin 500mg b.d, for ten days. Group C: Omeprazole 20mg b.d, Amoxicillin lgr b.d both for two weeks and ciprofloxacin 500mg b.d just for the first week. Group I): Omeprazole 20mg b.d for ten days with amoxicillin lgr b.d for first 5 days then metronidazole 500mg b.d and clathromycin 500mg b.d 5 days. Result was assessed at least 2 month after the end of antimicrobial therapy by stool Ag H.pylori test and 13C Urea Breath Test. We used SPSS 14 and our data were analyzed by chi-square. P-vallue <0.05 was considered statistically significant. Results: H.pylori eradication was achieved in 84.1%, 90.7%, 65.4% and 80.4% in groups A, B, C and D, respectively. The eradication rate in group B was higher than group D ( Pvalue <0.05) and group C ( Pvalue <0.0001), while no significant differences were observed between group B and A. Our study showed group B is most effective regimen for eradication of H.pylori infection and group C is less effective. Conclusion: This study showed that in our region, clarithromycin based triple therapy is first choice for treatment of Helicobacter pylori infection. If the cost of prescribing drug is important, metronidazole based quadruple therapy can be used as an alternative.