Hoshiya S, Watanabe K, Tokunaga K, Tanaka A, Ninomiya H, Shingaki M, Itoh T, Saito S, Ishida H, Takahashi S
The Third Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.
J Gastroenterol. 2000;35(1):10-4.
Since clarithromycin is expected to be widely used to treat Helicobacter pylori infection in the near future, it is important to investigate the relationship between resistance to clarithromycin and the regimens of eradication therapy. We investigated: (1) the usefulness of susceptibility tests prior to eradication therapy, and (2) the rate of acquisition of H. pylori resistance to clarithromycin after treatment failure. Drug susceptibility tests to clarithromycin and amoxicillin were conducted by Dry Plate Test or E-test. The subjects in the first part of this study included 112 patients with H. pylori infection who received triple therapy with various combinations of drugs, including clarithromycin. The eradication rate in patients with clarithromycin-susceptible H. pylori was significantly higher than that in patients with clarithromycin-resistant H. pylori. The second part of this study included 21 patients in whom H. pylori was not eradicated by triple therapy and 12 patients in whom H. pylori was not eradicated with dual therapy including clarithromycin. Of the 33 patients showing non-eradication. 90.9% of those treated with dual therapy and 35.7% of those treated with triple therapy acquired secondary resistance of H. pylori to clarithromycin. We conclude that it is important to conduct drug susceptibility tests prior to treatment of H. pylori infection. Since the incidence of acquiring clarithromycin resistance was significantly higher in the patients showing non-eradication, it is important to choose a regimen with a higher eradication rate, such as triple therapy.
由于预计在不久的将来克拉霉素将被广泛用于治疗幽门螺杆菌感染，因此研究对克拉霉素的耐药性与根除治疗方案之间的关系非常重要。我们进行了以下研究：（1）根除治疗前药敏试验的有效性，以及（2）治疗失败后幽门螺杆菌对克拉霉素获得性耐药率。采用干板试验或E-test法对克拉霉素和阿莫西林进行药敏试验。本研究第一部分的受试者包括112例幽门螺杆菌感染患者，他们接受了包括克拉霉素在内的各种药物组合的三联疗法。对克拉霉素敏感的幽门螺杆菌患者的根除率显著高于对克拉霉素耐药的幽门螺杆菌患者。本研究的第二部分包括21例三联疗法未能根除幽门螺杆菌的患者和12例包括克拉霉素的双联疗法未能根除幽门螺杆菌的患者。在这33例未根除的患者中，接受双联疗法的患者中有90.9%，接受三联疗法的患者中有35.7%的患者幽门螺杆菌获得了对克拉霉素的继发性耐药。我们得出结论，在治疗幽门螺杆菌感染之前进行药敏试验很重要。由于未根除的患者中获得克拉霉素耐药的发生率显著更高，因此选择根除率更高的方案，如三联疗法很重要。
