基于利福布汀的三联疗法用于根除对替硝唑和克拉霉素原发性及继发性耐药的幽门螺杆菌。

Rifabutin based triple therapy for eradication of H. pylori primary and secondary resistant to tinidazole and clarithromycin.

作者信息

Toracchio S, Capodicasa S, Soraja D B, Cellini L, Marzio L

机构信息

Section of Molecular Pathology, Department of Oncology and Neuroscience, G. d'Annunzio University, Chieti-Pescara, Italy.

出版信息

Dig Liver Dis. 2005 Jan;37(1):33-8. doi: 10.1016/j.dld.2004.09.008.

DOI:10.1016/j.dld.2004.09.008

PMID:15702857

Abstract

BACKGROUND

Rifabutin has been empirically used in Helicobacter pylori infections resistant to triple therapy. There are no data on primary and secondary resistance to rifabutin and its use in specific cases.

AIM

To analyse the susceptibility and resistance to rifabutin in H. pylori-positive patients with or without previous H. pylori therapy and to test the efficacy of rifabutin in H. pylori resistant to clarithromycin and tinidazole.

METHODS

Four hundred and twenty H. pylori-positive patients without previous exposure to triple therapy and 104 patients who had already received one course of triple therapy underwent upper endoscopy for dyspeptic symptoms and H. pylori susceptibility test. Amoxicillin, clarithromycin, tinidazole and rifabutin were evaluated for resistance and susceptibility. Forty patients with primary resistance to both clarithromycin and tinidazole and with susceptibility to amoxicillin and rifabutin, and 65 patients with secondary resistance and susceptibility to the same antibiotics were identified. All these patients received a 10-day triple therapy with pantoprazole amoxicillin and rifabutin. Treatment success was evaluated by the 13C-Urea Breath test.

RESULTS

In naive patients 23% of strains were resistant to clarythromycin, 35% to tinidazole, 9% to both antibiotics, and none was resistant to rifabutin In patients already treated the percentages of resistant strains were 76, 64.4, 62.5 and 1%, respectively. With rifabutin based triple therapy eradication rates were (Per Protocol and Intention-to-Treat analysis) 100 and 87.5% in primary resistance to clarithromycin and tinidazole and 82.2 and 78.5% in secondary resistance.

CONCLUSION

H. pylori primary and secondary resistances to clarithromycin and tinidazole are high in our geographic area, while resistance to rifabutin is rare. Rifabutin-based triple therapy, can be successfully used in primary and secondary resistance to clarithromycin and tinidazole according to the in vitro susceptibility test.

摘要

背景

利福布汀已被经验性用于对三联疗法耐药的幽门螺杆菌感染。目前尚无关于利福布汀的原发性和继发性耐药及其在特定病例中的应用的数据。

目的

分析幽门螺杆菌阳性患者（无论之前是否接受过幽门螺杆菌治疗）对利福布汀的敏感性和耐药性，并测试利福布汀对克拉霉素和替硝唑耐药的幽门螺杆菌的疗效。

方法

420例未接受过三联疗法的幽门螺杆菌阳性患者和104例已接受过一个疗程三联疗法的患者因消化不良症状接受了上消化道内镜检查及幽门螺杆菌敏感性检测。评估了阿莫西林、克拉霉素、替硝唑和利福布汀的耐药性和敏感性。确定了40例对克拉霉素和替硝唑均原发性耐药但对阿莫西林和利福布汀敏感的患者，以及65例对相同抗生素继发性耐药但敏感的患者。所有这些患者均接受了为期10天的泮托拉唑、阿莫西林和利福布汀三联疗法。通过13C-尿素呼气试验评估治疗效果。

结果

在未接受过治疗的患者中，23%的菌株对克拉霉素耐药，35%对替硝唑耐药，9%对两种抗生素均耐药，且无一例对利福布汀耐药。在已接受过治疗的患者中，耐药菌株的百分比分别为76%、64.4%、62.5%和1%。基于利福布汀的三联疗法的根除率（符合方案分析和意向性分析）在对克拉霉素和替硝唑原发性耐药时分别为100%和87.5%，在继发性耐药时分别为82.2%和78.5%。