The Korean Journal of Gastroenterology (대한소화기학회지)

The Korean Society of Gastroenterology (대한소화기학회)
권호 표지

The Trend of Eradication Rates of Second-Line Quadruple Therapy Containing Metronidazole for Helicobacter pylori Infection: An Analysis of Recent Eight Years

Helicobacter pylori 일차 제균에 실패한 환자에서 Metronidazole을 기본으로 한 사제 병합요법의 제균율: 최근 8년간에 걸친 변화 양상

Lee, Jeong-Hoon;Cheon, Jae-Hee;Park, Min-Jung;Kim, Na-Young;Lee, Dong-Ho;Kim, Jung-Mogg;Kim, Joo-Sung;Jung, Hyun-Chae;Song, In-Sung
이정훈;천재희;박민정;김나영;이동호;김정목;김주성;정현채;송인성

  • Published : 20050800
⟨ Previous Next ⟩

Abstract

Background/Aims: Failure rates of Helicobacter pylori eradication treatment turned out to be exceeding 10%, causing recurrence of peptic ulcers. In the case of eradication failure, the Korean College of Helicobacter Research and Practice recommends quadruple therapy consisting of proton pump inhibitor, bismuth, tetracycline and metronidazole. Many reports regarding the eradication rates of quadruple therapy have been reported. However, most were limited by short follow-up periods. Hence, we evaluated the efficacy of the metronidazole containing quadruple therapy as a second line treatment from April, 1996 through July, 2004. Methods: Sixty-three patients were enrolled. Treatment consisted of aforementioned quadruple therapy for 1 week. Four to six weeks after completion of treatment, biopsies and CLO tests were performed to detect the presence of H. pylori. The patients were then followed-up with upper endoscopy once every year. Results: The efficacy of the quadruple therapy was 74.6% in intention-to-treat analysis and 83.9% in per protocol analysis. Eradication rates of the years 1996, 1999- 2000, 2001, and 2002-2004 were 75.0%, 93.8%, 100%, and 72.7%, respectively. Conclusions: Our data can not reveal the evidence of decreasing trend for eradication rate quadruple therapy of H. pylori in 8 years. However, eradication rate of 72.7% in recent 2 years necessitates the development of more efficient eradication regimen.

목적: Helicobacter pylori는 만성 위염 및 소화성 궤양의 주요 위험인자로 현재 우리나라에서는 일차 제균 치료로 삼제요법을 시행하고 있으나 제균 실패율은 10-20%에 달하고 있다. 이들에 대한 재치료로 프로톤펌프억제제(PPI), bismuth, tetracycline, metronidazole로 구성된 사제 요법이 추천되고 이의 제균율이 다양하게 보고된다. 그러나 대부분 단기간에 시행된 연구들이어서 제균율 변화 양상에 대한 보고 는 부족한 실정이다. 이번 연구에서는 최근 8년간에 걸친 metronidazole 기본 사제요법의 제균율 변화를 알아보고자 하였다. 대상 및 방법: 1996년 4월에서 2004년 7월까지 서울대학교병원을 방문한 소화성 궤양 환자들 중에서 일차 삼제 제균요법 후 추적 관찰 중 H. pylori가 양성인 환자 63명을 대상으로 PPI (omeprazole or pantoprazole), bismuth, tetracycline, metronidazole으로 구성된 사제요법을 1주일간 시행하였다. 결과: 7명이 추적 관찰 과정에서 탈락되었고 사제요법의 제균율은 intention-to-treat 분석에서 74.6%, per-protocol(PP) 분석에서는 83.9%였다. 56명 중 1996년에 이차 제균 치료를 받은 20명의 제균율은 75%, 1999년부터 2000년까지 이차 제균 치료를 받은 16명의 제균율은 93.8%, 2001년에 이차 제균 치료를 받은 9명의 제균율은 100%였고, 2002년부터 2004년까지 이차 제균 치료를 받은 11명의 제균율은 72.7%였다. 이 네 군의 선형대선형결합의 유의확률은 0.806으로 통계 유의성은 없었다. 결론: Metronidazole을 기본으로 하는 사제요법은 8년 동안의 제균율 감소 경향을 보이지는 않았으나, 최근 2년 여간의 제균율이 72.7% (PP 분석)로 낮아 80-90% 이상의 제균율을 보장해 주는 새로운 이차 요법의 개발이 필요하다.

Keywords

References

  1. Kim JM, Kim JS, Jung HC, Kim N, Song IS. Antibiotic resistance of Helicobacter pylori isolated from Korean patients in 2003. Korean J Gastroenterol 2004;44:126-135
  2. McMahon BJ, Hennessy TW, Bensler JM, et al. The relationship among previous antimicrobial use, antimicrobial resistance, and treatment outcomes for Helicobacter pylori infections. Ann Intern Med 2003;139:463-469 https://doi.org/10.7326/0003-4819-139-6-200309160-00008
  3. Park MJ, Choi IJ, Kim JS, et al. Efficacy of quadruple therapy as retreatment regimen in Helicobacter pylori-positive peptic ulcer disease. Korean J Gastroenterol 2000;36:457-464
  4. Guidelines for clinical trials in Helicobacter pylori infection. Working Party of the European Helicobacter pylori Study Group. Gut 1997;41(suppl 2):1S-9S https://doi.org/10.1136/gut.41.1.1
  5. Lam SK, Talley NJ. Report of the 1997 Asia Pacific Consensus Conference on the management of Helicobacter pylori infection. J Gastroenterol Hepatol 1998;13:1-12 https://doi.org/10.1111/j.1440-1746.1998.tb00537.x
  6. Choung RS, Lee SW, Kim MJ, Kim YS, Yim HJ, Kim JY. Quadruple therapy is an effective salvage regimen for Helicobacter pylori infection. Annual Conference of Japan-Korea joint meeting on Helicobacter infection 2004;1:78
  7. Kim JJ, Reddy R, Lee M, et al. Analysis of metronidazole, clarithromycin and tetracycline resistance of Helicobacter pylori isolates from Korea. J Antimicrob Chemother 2001;47:459-461 https://doi.org/10.1093/jac/47.4.459
  8. Han DS, Cho YJ, Son JH, Park KM, Kang JO. Antimicrobial resistances of Helicobacter pylori in Korean patients with duodenal ulcer. Korean J Gastroenterol 1997;29:727-733
  9. Kim JM, Kim JS, Jung HC, Kim N, Kim YJ, Song IS. Distribution of antibiotic MICs for Helicobacter pylori strains over a 16-year period in patients from Seoul, South Korea. Antimicrob Agents Chemother 2004;48:4843-4847 https://doi.org/10.1128/AAC.48.12.4843-4847.2004
  10. Murakami K, Sato R, Okimoto T, et al. Efficacy of triple therapy comprising rabeprazole, amoxicillin and metronidazole for second-line Helicobacter pylori eradication in Japan, and the influence of metronidazole resistance. Aliment Pharmacol Ther 2003;17:119-123
  11. Kamada T, Haruma K, Hata J, et al. The long-term effect of Helicobacter pylori eradication therapy on symptoms in dyspeptic patients with fundic atrophic gastritis. Aliment Pharmacol Ther 2003;18:245-252 https://doi.org/10.1046/j.1365-2036.2003.01669.x
  12. Chi CH, Lin CY, Sheu BS, Yang HB, Huang AH, Wu JJ. Quadruple therapy containing amoxicillin and tetracycline is an effective regimen to rescue failed triple therapy by overcoming the antimicrobial resistance of Helicobacter pylori. Aliment Pharmacol Ther 2003;18:347-353 https://doi.org/10.1046/j.1365-2036.2003.01653.x
  13. Lee JY, Kim W, Gwak GY, et al. Reinfection rate and clinical manifestation of Helicobacter pylori-positive peptic ulcer disease after triple therapy containing clarithromycin. Korean J Gastroenterol 2002;39:93-100
  14. Kim N, Lim CN, Lim SH, et al. Establishment of an Helicobacter pylori-eradication regimen in consideration of drug resistance, recrudescence and reinfection rate of H. pylori. Korean J Med 1999;56:279-291