Branca Giovanna, Spanu Teresa, Cammarota Giovanni, Schito Anna Maria, Gasbarrini Antonio, Gasbarrini Giovanni Battista, Fadda Giovanni
Institute of Microbiology, Catholic University of the Sacred Hearth, Rome, Italy.
Int J Antimicrob Agents. 2004 Nov;24(5):433-8. doi: 10.1016/j.ijantimicag.2004.02.032.
Current treatment for Helicobacter pylori infections generally includes two or more antimicrobials (amoxicillin, clarithromycin, nitroimidazoles, tetracycline, etc.), but treatment fails in 10-20% of all cases, often because of drug resistance. Levofloxacin has been proposed as an alternative for these refractory infections. We examined 67 H. pylori isolates from patients unsuccessfully treated with amoxicillin, clarithromycin, metronidazole and levofloxacin. Minimum inhibitory concentrations determined with the epsilometer test revealed clarithromycin and metronidazole resistance in 91 and 82.1% of the isolates, respectively; 52 (77.6%) were resistant to both drugs. All 67 isolates were susceptible to amoxicillin and tetracycline. Fifty-two isolates had levofloxacin MICs of 0.01-2 mg/l; the remaining 15 (22.4%), all clarithromycin- and metronidazole-resistant, had MICs >/= 8 mg/l. Levofloxacin may be an option for refractory H. pylori infections, but the choice should be based on in vitro susceptibility data, and physicians should consider local resistance patterns when treating these infections empirically.
目前幽门螺杆菌感染的治疗通常包括两种或更多种抗菌药物（阿莫西林、克拉霉素、硝基咪唑类、四环素等），但在所有病例中有10%-20%的治疗失败，通常是由于耐药性。左氧氟沙星已被提议作为这些难治性感染的替代药物。我们检测了67株来自接受阿莫西林、克拉霉素、甲硝唑和左氧氟沙星治疗失败患者的幽门螺杆菌分离株。用E试验测定的最低抑菌浓度显示，分别有91%和82.1%的分离株对克拉霉素和甲硝唑耐药；52株（77.6%）对两种药物均耐药。所有67株分离株对阿莫西林和四环素敏感。52株分离株的左氧氟沙星最低抑菌浓度为0.01-2mg/L；其余15株（22.4%），均对克拉霉素和甲硝唑耐药，最低抑菌浓度≥8mg/L。左氧氟沙星可能是难治性幽门螺杆菌感染的一种选择，但选择应基于体外药敏数据，医生在经验性治疗这些感染时应考虑当地的耐药模式。
