32 歲女性初診斷為 H.

pylori 引起的消化性潰瘍，醫生決定處方三合一療法：
lansoprazole 30mg bid, clarithromycin 500mg bid, amoxicillin 1g bid 用藥 14 天，但
核對藥師某天晨會聽學長說 2007 年美國家庭醫學期刊建議用藥 7 天即可，於是
進行以下求證：
P：32 歲女性有 H. pylori 引起的消化性潰瘍
I：三合一療法用藥 7 天
C：三合一療法用藥 14 天
O：H. pylori 根除率
於 PubMed 搜尋文獻，運用關鍵字：triple regimen, PPI, duration；設限條件：近
5 年內報告, human, English, Chinese 得到結果為：共 14 篇，其中 6 篇為綜述文章。

1.Comparison of 7-day and 14-day proton pump inhibitor-containing triple therapy for
Helicobacter pylori eradication: neither treatment duration provides acceptable eradication
rate in Korea. Helicobacter. 2007 Feb;12(1):31-5. (1b)
CONCLUSIONS: Although the 7-day PPI-containing triple anti-H. pylori therapy is
not inferior to the 14-day therapy, neither treatment duration provides acceptable
eradication rate reaching 90% in per-protocol analysis. New combination regimen
with higher efficacy should be developed as a first-line eradication therapy for H.
pylori in Korea.

2. 2-week triple therapy for Helicobacter pylori infection is better than 1-week in clinical
practice: a large prospective single-center randomized study. Helicobacter. 2006
Dec;11(6):562-8.(1b)
CONCLUSIONS: Two-week therapies, independently of antibiotic combination, lead
to a significant increase of H. pylori eradication rate compared to 1-week therapies,
with same compliance and tolerability, even if, taking account of low-eradication
rates, one must question whether the triple therapy should still be used.
同一期刊先後發表出迥異結論。可能搜尋條件太嚴苛查得文獻較少，無一致性實
驗結果。設限條件同上，轉換關鍵字：PPI And H pylori And duration 或 PPI, H
pylori, duration 無論使用逗號或布林邏輯”And”都可查出相同文獻與結果，共
25 篇。

Meta-analysis: duration of first-line proton-pump inhibitor based triple therapy for

Helicobacter pylori eradication.
Ann Intern Med. 2007 Oct 16;147(8):553-62(1a)證據等級比之前強。詳細內文請按

Meta-analysis yielded relative risks (RRs) for eradication of 1.05 (95% CI, 1.01 to
1.10) for 7-day compared with 10-day amoxicillin-containing triple therapy (10
studies) and 1.07 (CI, 1.02 to 1.12) for 7-day compared with 14-day therapy (11
studies).
CONCLUSION: Available data suggest that extending triple therapy beyond 7 days is
unlikely to be a clinically useful strategy.
建議與評論：
1.如果有抗藥性則另外考量，就現有文獻來看，既然 14 天療程與 7 天療程無明
顯差異，此初診斷為 H. pylori 引起的消化性潰瘍者建議使用 7 天療程之三合一
療法。
2.自然界細菌突變產生抗藥性並非偶然，殊不知療程縮短、三合一療法中抗生素
用藥久了之後是否反而產生抗藥菌，值得後續觀察。搜尋文獻時偶然看到一些回
溯性非雙盲實驗提醒：Clarithromycin resistance is associated with eradication
failure. Metronidazole is a good substitute for clarithromycin.[ J Gastroenterol. 2004
Sep;39(9):838-43.]；Rates of H. pylori eradication with the triple-therapy regimen
decreased in Turkey over the 10-year period studied. In an era of increasing
clarithromycin use, the effectiveness of this regimen for H. pylori eradication appears
to require reassessment.[ Clin Ther. 2006 Nov;28(11):1960-6.]
ps:學長說的那ㄧ篇用藥 7 天的期刊係 Adrienne Z. Ables, I Simon, Emily R. Melton
Update on Helicobacter pylori Treatment American Family Physcian 2007;75:351-
358. 依據 2007 年 2 月美國家庭醫學期刊上分析的報導，無論是 3 合 1 或 4 合
1，用 clarithromycin 或用 metronidazole 都可於 3-5 天清除 90％以上的幽門桿菌，
同時，3-5 天清除後，半年及一年的碳 13 尿素酶呼吸測試，仍然顯示幽門桿菌
的清除超過 8 成以上，這顯示過去我們對於幽門桿菌的清除至少二週以上的療
程可能需要修正。詳細內文請按