Tankovic J, Lamarque D, Lascols C, Soussy C J, Delchier J C
Service de bactériologie, hôpital Henri-Mondor, 51, avenue du maréchal de Lattre de Tassigny, 94010 Créteil, France.
Pathol Biol (Paris). 2001 Sep;49(7):528-33. doi: 10.1016/s0369-8114(01)00209-7.
Clarithromycin resistance of Helicobacter pylori is relatively frequent in France and is assumed to be the main cause of failure of the proton pump inhibitor-amoxicillin-clarithromycin (PPI-AC) therapy, which is the first-line regimen in our country. We determined the respective effects of clarithromycin primary and secondary resistances on efficacy of the PPI-AC regimen and examined whether failures were associated with persistence of the same strain or with emergence of a new one. Hundred and twenty three H. pylori-infected patients were treated for seven days with omeprazole 20 mg b.d., amoxicillin 1 g b.d., and clarithromycin 500 mg b.d. Eradication was assessed by breath test in 102 patients. MICs of clarithromycin were determined by E-test. Strain genotyping was performed by random amplified polymorphic DNA. The pre-treatment and post-treatment prevalences of clarithromycin resistance were 18.7% (23/123) and 69.2% (9/13), respectively. The rates of eradication were 67.6% (69/102), 78.8% (67/85), and 11.8% (2/17) for all, susceptible and resistant strains, respectively. The post-treatment isolate was available for six patients with a susceptible pre-treatment isolate and a persistent infection; resistance emerged in two patients and was associated with persistence of the pre-treatment strain in one and with selection of a new strain in the other. In conclusion, in our hospital, failures of the PPI-AC therapy are related to both clarithromycin primary and secondary resistances but emergence of secondary resistance does not explain all failures in the initial clarithromycin-susceptible group. In that group a new strain can emerge after failure.
在法国，幽门螺杆菌对克拉霉素的耐药性相对常见，并且被认为是质子泵抑制剂 - 阿莫西林 - 克拉霉素（PPI - AC）疗法失败的主要原因，而该疗法是我国的一线治疗方案。我们确定了克拉霉素原发耐药和继发耐药对PPI - AC方案疗效的各自影响，并研究了治疗失败是否与同一菌株的持续存在或新菌株的出现有关。123例幽门螺杆菌感染患者接受了为期7天的治疗，服用奥美拉唑20毫克，每日两次，阿莫西林1克，每日两次，克拉霉素500毫克，每日两次。通过呼气试验对102例患者进行了根除评估。采用E试验测定克拉霉素的最低抑菌浓度（MIC）。通过随机扩增多态性DNA进行菌株基因分型。克拉霉素耐药的治疗前和治疗后患病率分别为18.7%（23/123）和69.2%（9/13）。所有菌株、敏感菌株和耐药菌株的根除率分别为67.6%（69/102）、78.8%（67/85）和11.8%（2/17）。有6例治疗前菌株敏感但仍持续感染的患者，其治疗后分离株可用；其中2例出现耐药，1例与治疗前菌株的持续存在有关，另1例与新菌株的选择有关。总之，在我们医院，PPI - AC疗法的失败与克拉霉素原发耐药和继发耐药均有关，但继发耐药的出现并不能解释初始克拉霉素敏感组中的所有治疗失败情况。在该组中，治疗失败后可能会出现新菌株。
