Curative Effect Analysis Of Rescue Therapy After The Failure Of The First Eradication Of H.pylori

Objective :Through clinical observation of patients receiving sequential therapy and quadruple therapy after the failure of the initial eradication of H. pylori based on the initial standard triple therapy, the aim of our study was to evaluate the eradication rates, adverse reactions and costs of sequential therapy and quadruple therapy as rescue therapies.Methods:79 cases who stopped medication for at least 3 months after failed eradication of H. pylori based on the initial standard triple therapy in digestion internal clinic in the Initial Affiliated Hospital of Medical College of Shihezi University from November 2013 to October 2014 for upper digestive tract symptoms were paired and enrolled into two different treatment groups: group A(39 cases) received sequential therapy, namely 40 mg of pantoprazole(qd) + 0.5g of levofloxacin(qd) for the initial 5 days, and 40 mg of clarithromycin(qd) + 0.5g of levofloxacin(bid)+0.5g of tinidazole(bid) for the last 5 days; group B(40cases) received quadruple therapy, namely 40 mg of pantoprazole(qd) + 200 mg of colloidal bismuth pectin(qd) + 1.0g of amoxicillin(tid) + 0.5g of clarithromycin(bid). Both groups were treated for 10 days.14C-urea breath test was carried out to judge the eradication of H. pylori when patients were reviewed after stopping medication for at least 4 weeks. Positive results indicated failed eradication of H. pylori,while negative results indicated successful eradication of H. pylori. Both groups were evaluated in terms of drug cost and adverse reactions during the period of taking medicine.Results:79 cases(36 males and 43 females, with a mean age of 47.5±11.8 years old) who stopped medication for at least 3 months after failed eradication of H. pylori based on the initial standard triple therapy were paired and enrolled into group A(sequential therapy) and group B(quadruple therapy). 75 patients finished the whole rescue therapy cycle of H. pylori eradication and were followed up.1.After the treatment, the intentional analysis(ITT) showed that the H. pylori eradication rates in group A and B were 66.67% and 70.0% respectively, and there was no statistically significant difference between the two groups(P>0.05); according to the pre-protocol analysis, the H. pylori eradication rates in group A and B were 70.27% and 73.68% respectively, showing no statistically significant difference between the two groups(P>0.05).2. During the treatment, the rate of drug adverse reactions in group A and B were 15.4% and 10.0%respectively, and there was no statistically significant difference between the two groups(P>0.05).3.The drug costs in group A(sequential therapy) and group B(quadruple therapy) were 364.41 yuan and538.03 yuan.Conclusions:1.Both sequential therapy and quadruple therapy can effectively eradicate H. pylori infection after the failure of the initial eradication treatment.2.Both sequential therapy and quadruple therapy cause no drug adverse reactions.3.Sequential therapy needs lower costs than quadruple therapy, so the former is more worth promoting in providing rescue therapy for patients who failed in the initial eradication of H. pylori.