抗生素耐药性对三种针对幽门螺杆菌的1周三联疗法治疗效果的影响。
The effect of antibiotic resistance on the outcome of three 1-week triple therapies against Helicobacter pylori.
作者信息
Pilotto A, Leandro G, Franceschi M, Rassu M, Bozzola L, Furlan F, Di Mario F, Valerio G
机构信息
Department of Geriatrics, S. Bortolo Hospital, Vicenza, Italy.
出版信息
Aliment Pharmacol Ther. 1999 May;13(5):667-73. doi: 10.1046/j.1365-2036.1999.00508.x.
BACKGROUND
Resistance of Helicobacter pylori to antibiotics may be a major reason for treatment failure.
AIM
To evaluate the effect of primary H. pylori resistance to antibiotics on the cure rates of three anti-H. pylori 1-week triple therapies.
METHODS
One hundred and sixteen consecutive patients diagnosed H. pylori-positive by gastric histology, rapid urease test and culture were enrolled. Activity of tested antibiotics was determined by means of the E-test. Patients were treated for 7 days with: (i) pantoprazole 40 mg o.d. plus amoxycillin 1 g b.d. and metronidazole 250 mg q.d.s. (PAM); (ii) pantoprazole 40 mg o.d. plus clarithromycin 250 mg b.d. and metronidazole 250 mg q.d.s. (PCM); or (iii) pantoprazole 40 mg o.d. plus amoxycillin 1 g b.d. and clarithromycin 250 mg b.d. (PAC). Two months after completion of therapy, endoscopy and gastric biopsies were repeated.
RESULTS
Primary resistance rates to metronidazole, clarithromycin and amoxycillin were 17.2, 6.9 and 0%, respectively. Overall H. pylori cure rates expressed as intention-to-treat and per protocol analyses were, respectively, 79% and 86% with PAM, 82% and 89% with PCM, and 85% and 85% with PAC. Significantly lower cure rates were observed in metronidazole-resistant patients treated with PAM (56% vs. 96%, P = 0.01) or PCM (50% vs. 97%, P = 0.01). A trend towards lower H. pylori cure rates was observed in clarithromycin-resistant patients treated with PCM (67% vs. 91%, P = 0.74) or PAC (50% vs. 87%, P = 0.68).
CONCLUSION
Primary resistance to metronidazole influences the H. pylori cure rate of anti-H. pylori proton pump inhibitor-based triple therapies which include this antibiotic. A similar trend exists for primary clarithromycin resistance.
背景
幽门螺杆菌对抗生素的耐药性可能是治疗失败的主要原因。
目的
评估幽门螺杆菌对抗生素的原发性耐药性对三种抗幽门螺杆菌1周三联疗法治愈率的影响。
方法
连续纳入116例经胃组织学、快速尿素酶试验和培养确诊为幽门螺杆菌阳性的患者。通过E试验测定受试抗生素的活性。患者接受7天治疗，治疗方案如下：（i）泮托拉唑40mg每日一次加阿莫西林1g每日两次和甲硝唑250mg每日四次（PAM）；（ii）泮托拉唑40mg每日一次加克拉霉素250mg每日两次和甲硝唑250mg每日四次（PCM）；或（iii）泮托拉唑4mg每日一次加阿莫西林1g每日两次和克拉霉素250mg每日两次（PAC）。治疗结束两个月后，重复进行内镜检查和胃活检。
结果
对甲硝唑、克拉霉素和阿莫西林的原发性耐药率分别为17.2%、6.9%和0%。以意向性分析和符合方案分析表示的总体幽门螺杆菌治愈率，PAM分别为79%和86%，PCM分别为82%和89%，PAC分别为85%和85%。在用PAM（56%对96%，P=0.01）或PCM（50%对97%，P=0.01）治疗的甲硝唑耐药患者中，观察到治愈率显著降低。在用PCM（67%对91%，P=0.74）或PAC（50%对87%，P=0.68）治疗的克拉霉素耐药患者中，观察到幽门螺杆菌治愈率有降低趋势。
结论
对甲硝唑的原发性耐药性会影响基于质子泵抑制剂的抗幽门螺杆菌三联疗法（包括该抗生素）的幽门螺杆菌治愈率。对克拉霉素的原发性耐药性也存在类似趋势。
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