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Árangur þriggja lyfja meðferðar gegn Helicobacter pylori hjá sjúklingum með skeifugarnasár

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Authors
Hallgrímur Guðjónsson
Herdís Ástráðsdóttir
Bjarni Þjóðleifsson
Issue Date
1995-04-01

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Other Titles
Helicobacter pylori infection: The efficacy of bismuth-tetracyclin-metronidazole triple therapy in patients with duodenal ulcer
Citation
Læknablaðið 1995, 81(4):303-7
Abstract
The aim of the study was to assess the efficacy of two bismuth-tetracyclin-metronidazole „triple therapy" regimes for Helicobacter pylori and their effect of eradication of the bacteria on duodenal ulcer disease. Eighty-two patients (52 males and 30 females, mean age 49 years) with a history of recurrent duodenal ulcer and H. pylori postitive gastritis were included in the study. Treatment I, 35 patients, received colloid bismuth subcitrate (De-Nol®) 120 mg q.i.d, tetracyclin 500 mg q.i.d. and metronidazole 400 mg t.i.d. for 14 days. Most patients received omeprazole or H2 blocker during the treatment. Treatment II, 47 patients, received omeprazole 20 mg o.d. on days 1-14 and colloid bismuth subcitrate 120 mg q.i.d., tetracyclin 250 mg q.i.d. and metronidazole 250 mg q.i.d. on days 4-14. Eradication was regarded successful if gastric biopsy was H. pylori negative by urease test three months or more after treatment. All patients were able to complete the treatment. Eradication of H. pylori was successful in 34 (97%) in group I and in 43 (92%) in group II. The mean endoscopic follow-up period was 9.4 months in group I and 16.0 in group II. Follow-up with regard to subjective symptoms was on average 20 months long. Five patients in group I and eight in group II had a mild symptom recurrence without reinfection. Two (2.5%) patients (one in each group) had a recurrent ulcer. Adverse effects were common in both groups and four patients, all in group I, had severe symptoms. It was estimated that the successful H. pylori eradication and excellent symptom response in most of the patients had saved seven million Icelandic krónur in drug expenses in the whole group.
Tilgangur rannsóknarinnar var að meta virkni tveggja mismunandi útfærslna á þriggjalyfja meðferð, bismút, tetracýklín og metrónídazól, við Helicobacter pylori sýkingu. Ennfremur að kanna áhrif upprætingar á H. pylori á sjúkdómsgang skeifugarnarsárs. Rannsóknin náði til 82 sjúklinga (50 karla og 32 kvenna, meðalaldur 49 ár), sem allir höfðu sögu um þrálát skeifugarnarsár og H. pylori sýkingu. Hópur I (35 sjúklingar) fengu colloid bismút subcítrat (De-Nol®) 120mg x 4, tetracýklín 500 mg x 4 og metrónídazól 400 mg x 3 í 14 daga. Flestir fengu einnig H2 blokka eða ómeprazól meðan á meðferð stóð. Hópur II (47 sjúklingar) fékk ómeprazól 20 mg á fyrsta degi til 14. dags, colloid bismút subcítrat 120 mg x 4, tetracýklín 250 mg x 4 og metrónídazól 250 mg x 4 á fjórða degi til 14. dags. Uppræting á H. pylori var talin hafa tekist ef magasýni var H. pylori neikvætt á úreasa prófi þremur mánuðum eða síðar eftir meðferð. Uppræting tókst hjá 34 (97%) í hópi I og 43 (92%) í hópi II. Meðaltími frá meðferð til speglunar var 9,4 mánuðir í hópi I og 16 mánuðir í hópi II. Eftirlit með tilliti til einkenna var að meðaltali 20 mánuðir. Fimm sjúklingar í hópi I og átta í hópi II fengu einkenni án endursýkingar að nýju í stuttan tíma. Tveir (2,5%) sjúklingar, einn í hvorum hópi, fengu sár að nýju. Aukaverkanir voru algengar, flestar vægar nema hjá fjórum sjúklingum í hópi I sem fengu slæmar aukaverkanir. Það var áætlað að meðferðin hafi sparað sjö milljónir króna í lyfjakostnað hjá samanlögðum hópnum á eftirlitstímanum.
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Icelandic Journal Articles (Peer Reviewed)

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