对抗生素的原发性耐药及其对基于兰索拉唑的幽门螺杆菌三联疗法疗效的临床影响。
Primary resistance to antibiotics and its clinical impact on the efficacy of Helicobacter pylori lansoprazole-based triple therapies.
作者信息
Poon S K, Chang C S, Su J, Lai C H, Yang C C, Chen G H, Wang W C
机构信息
Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
出版信息
Aliment Pharmacol Ther. 2002 Feb;16(2):291-6. doi: 10.1046/j.1365-2036.2002.01184.x.
AIM
To evaluate Helicobacter pylori primary resistance and its clinical impact on the efficacy of two lansoprazole-based eradication triple therapies.
METHODS
H. pylori-positive patients (n=228) were randomized to receive one of the 1-week regimens: lansoprazole 30 mg, clarithromycin 500 mg and amoxicillin 1 g (LAC), or lansoprazole 30 mg, clarithromycin 500 mg and metronidazole 500 mg (LMC), each given twice daily. H. pylori status was assessed by 13C-urea breath test and culture at diagnosis and by 13C-urea breath test 6 weeks after therapy. Antibiotic susceptibility was determined by E-test (n=98).
RESULTS
The eradication rates with per protocol/ intention-to-treat analyses were: LAC (n=95/114) 83%/69% and LMC (n=96/114) 85%/72%. Primary resistance was 11% for clarithromycin, 41% for metronidazole and 0% for amoxicillin. Eradication in metronidazole-susceptible/-resistant strains was 85%/82% in LAC and 83%/63% in LMC. Significantly lower cure rates were observed in clarithromycin-resistant patients treated with LAC (95% vs. 0%, P < 0.001) and LMC (86% vs. 0%, P < 0.001).
CONCLUSIONS
One-week LAC and LMC are similarly effective therapies. Clarithromycin resistance significantly affected H. pylori eradication in both regimens.
目的
评估幽门螺杆菌的初始耐药性及其对两种以兰索拉唑为基础的根除三联疗法疗效的临床影响。
方法
幽门螺杆菌阳性患者（n = 228）被随机分配接受以下1周治疗方案之一：兰索拉唑30 mg、克拉霉素500 mg和阿莫西林1 g（LAC），或兰索拉唑30 mg、克拉霉素500 mg和甲硝唑500 mg（LMC），均每日服用两次。在诊断时通过¹³C尿素呼气试验和培养评估幽门螺杆菌状态，并在治疗6周后通过¹³C尿素呼气试验评估。通过E-test测定抗生素敏感性（n = 98）。
结果
符合方案/意向性分析的根除率为：LAC组（n = 95/114）83%/69%，LMC组（n = 96/114）85%/72%。克拉霉素的初始耐药率为11%，甲硝唑为41%，阿莫西林为0%。LAC组中甲硝唑敏感/耐药菌株的根除率分别为85%/82%，LMC组分别为83%/63%。接受LAC治疗的克拉霉素耐药患者的治愈率显著较低（95%对0%，P < 0.001），LMC组也如此（86%对0%，P < 0.001）。
结论
1周的LAC和LMC是同样有效的疗法。克拉霉素耐药显著影响了两种方案中幽门螺杆菌的根除。
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