Alarcón T, Domingo D, López-Brea M
Department of Clinical Microbiology, Hospital Universitario de la Princesa, Madrid, Spain.
Int J Antimicrob Agents. 1999 Jun;12(1):19-26. doi: 10.1016/s0924-8579(99)00051-5.
Helicobacter pylori is very susceptible in vitro to most antibiotics, but when they are used in the clinical setting, eradication of the bacteria from the gastric mucosa is not obtained. Dual or triple therapy including two of the following antibiotics: amoxicillin, tetracycline, metronidazole or clarithromycin, plus a proton pump inhibitor, bismuth salt or ranitidine bismuth citrate is the most frequently used. Various in vitro susceptibility methods have been used: disk diffusion, agar dilution and Epsilometer test (E-test). Metronidazole resistance among H. pylori strains is now found worldwide, and resistance rates vary according to the population studied. It is higher in developing than in developed countries and it could reach 80-90% in Africa. The prevalence on clarithromycin resistance is much lower, usually below 10%, although very high values are reported in Peru. Infection with metronidazole- or clarithromycin-resistant H. pylori strains is correlated with treatment failure when using regimens including these antibiotics.
幽门螺杆菌在体外对大多数抗生素非常敏感，但在临床应用时，却无法从胃黏膜中根除该细菌。最常用的是双联或三联疗法，包括以下两种抗生素：阿莫西林、四环素、甲硝唑或克拉霉素，再加上一种质子泵抑制剂、铋盐或枸橼酸铋雷尼替丁。已经使用了各种体外药敏试验方法：纸片扩散法、琼脂稀释法和E试验（Epsilometer test）。目前在全球范围内都发现幽门螺杆菌菌株对甲硝唑耐药，耐药率因所研究的人群而异。发展中国家的耐药率高于发达国家，在非洲可能达到80%-90%。克拉霉素耐药的发生率要低得多，通常低于10%，不过秘鲁报告了非常高的耐药值。当使用包含这些抗生素的治疗方案时，感染对甲硝唑或克拉霉素耐药的幽门螺杆菌菌株与治疗失败相关。
