Resumo: o objetivo deste trabalho foi avaliar a eficácia de dois esquemas comumente empregados para a erradicação do Helicobacter py/ori e o impacto da resistência bacteriana nas taxas de erradicação. Noventa e dois pacientes Helicobacter py/ori-positivos com doença ulcerosa péptica ulcerosa, comprovada através de endoscopia digestiva alta, foram randomizados e receberam, durante sete dias um dos tratamentos: lansoprazol 30 mg, amoxicilina 1000 mg e claritromicina 500 mg (todos em duas tomadas diárias), ou subcitrato de bismuto 120 mg, tetraciclina 500 mg (ambos em quatro tomadas diárias) e furazolidona 200 mg (em duas tomadas diárias). A presença de Helicobacter py/ori foi investigada trinta dias após o término da terapia medicamentosa, através de nova endoscopia digestiva alta. Cinco pacientes de cada grupo de estudo não retomaram para o seguimento. Ambos os tratamentos resultaram em taxas similares de erradicação do H. py/ori: 66%-60% (pelo protocolo) e 59%-52% (intenção de tratar) no grupo A e B, respectivamente. Entretanto, na ausência de resistência bacteriana à claritromicina ou amoxicilina, foi encontrada taxa de erradicação de 79%. Pode-se concluir que, a resistência primária à claritromicina ou amoxicilina pode estar encobrindo um potencial, sério e não reconhecido problema na erradicação do Helicobacter py/ori. Testes de susceptibilidade a antimicrobianos tornam-se necessários para melhorar a eficácia terapêutica Ver menos

Abstract: Objective: To compare the efficacy of two regimens of triple therapy in patients with Helicobacter py/ori infection and peptic ulcer disease, and evaluate the impact of bacterial resistance to antibiotics on eradication rate. One of the regimens, consisted of lansoprazole, amoxicillin and clarithromycin, and the other consisted of bismuth, tetracycline and furazolidone. Methods: Ninety-two consecutive Helicobacter y/ori-positive patients with active peptic ulcer disease were randomly enrolled to receive either (A) lanzoprazole (Ogastro, Abbot, Brazil) 30 mg b.i.d., plus 1000 mg of amoxicillin (Amoxil, Smithkline Beecham, Brazil) b.i.d., plus clarithromycin (Klaricid, Abbot, Brazil) 500 mg b.i.d.; or (B) bismuth subcitrate (Peptulan, Farmasa, Brazil) 120 mg q.i.d., plus 500 mg of tetracycline (Terramicina, Pfizer, Brazil) q.i.d., plus furazolidone (Giarlan, UCI Farma, Brazil) 200 mg b.i.d.. Both groups (n = 46 each) received the medication for 1 week. The Helicobacter py/ori status was reassessed 30 days following completion of the therapy in order to evaluate eradication rates and bacterial resistance to the antibiotics was investigated using na in vitro assay. Results: Five patients from each study group were lost to follow up. Side effects were considered to be mild by individuais from both groups, except by one assigned to group B who could not complete the treatment. Both treatments resulted in similar H. py/ori eradication rate: 66% and 60% (per protocol), 59% and 52% (intention-to-treat) in group A and B, respectively (p>0.05, n.s.). However, eradication improved to 79% in the absence of Helicobacter pylori resistance to clarithromycin or amoxicillin. Similar healing rates were observed both groups by per protocol or intention-to-treat analysis. Conclusions: Primary resistance to clarithromycin or amoxicillin may underscore a potentially serious problem for the eradication of H. py/ori infection. Testing for bacterial resistance may become necessary to improve therapeutic efficacy. The results emphasise that caution must be exercised before suggesting Summary a general eradication therapy, which could be universally employed, or even a "test and treat" strategy in developing countries. Key words: clarithromycin, amoxycillin, tetracycline, furazolidone, bismuth subcitrate, lansoprazole, He/icobacter py/ori therapy, antibiotic resistance in Brazil Ver menos