Alarcón T, de la Obra P, Domingo D, García-Campos J A, Díaz-Regañón J, López-Brea M
Servicio de Microbiología, Hospital Universitario de la Princesa, Madrid.
Rev Esp Quimioter. 2005 Dec;18(4):313-8.
Clarithromycin, amoxicillin, tetracycline and metronidazole are the most frequently used antimicrobials for Helicobacter pylori infection treatment. While tetracycline and amoxicillin resistance are rare, clarithromycin and metronidazole resistance vary in different populations and are considered factors for treatment failure. The aim of this study was to determine the in vitro activity of furazolidone and nitrofurantoin in 164 H. pylori clinical isolates by agar dilution and to determine the spontaneous mutation rate. Metronidazole and clarithromycin resistance were 23.77% (CI95%: 18.96-29.14) and 16.78% (CI95%: 12.64-21.62), respectively; moreover, 1.4% (CI95%: 0.38-3.54) were intermediate to clarithromycin. All the isolates were susceptible to amoxicillin and tetracycline. Furazolidone and nitrofurantoin resistance rates were 1.82% (CI95%: 0.37-5.25) and 0.6% (CI95%: 0-3.35), respectively. The three furazolidone-resistant strains were nitrofurantoine-susceptible (MIC 4 mg/l for furazolidone and 2 mg/l for nitrofurantoin) and the nitrofurantoin-resistant strains were furazolidone-susceptible (MIC 4 mg/l for nitrofurantoin and 1 mg/l for furazolidone). These four strains were metronidazole-resistant (MIC 16 mg/l). Furazolidone or nitrofurantoin spontaneous mutants were not detected in the eight H. pylori strains tested. However, mutants with resistance to metronidazole were found with all the strains with a mutation rate of 7.4 x 10(-10) to 9.4 x 10(-10). Furazolidone and nitrofurantoin showed an excellent in vitro activity against the H. pylori clinical isolates included herein, supporting the usefulness of furazolidone as second-line antimicrobial after treatment failure or as first-line therapy in populations with low economical resources.
克拉霉素、阿莫西林、四环素和甲硝唑是治疗幽门螺杆菌感染最常用的抗菌药物。虽然四环素和阿莫西林耐药情况罕见，但克拉霉素和甲硝唑耐药情况在不同人群中有所不同，被认为是治疗失败的因素。本研究的目的是通过琼脂稀释法测定164株幽门螺杆菌临床分离株中呋喃唑酮和呋喃妥因的体外活性，并测定自发突变率。甲硝唑和克拉霉素耐药率分别为23.77%（95%置信区间：18.96 - 29.14）和16.78%（95%置信区间：12.64 - 21.62）；此外，1.4%（95%置信区间：0.38 - 3.54）对克拉霉素呈中介状态。所有分离株对阿莫西林和四环素敏感。呋喃唑酮和呋喃妥因耐药率分别为1.82%（95%置信区间：0.37 - 5.25）和0.6%（95%置信区间：0 - 3.35）。3株对呋喃唑酮耐药的菌株对呋喃妥因敏感（呋喃唑酮的最低抑菌浓度为4mg/l，呋喃妥因的最低抑菌浓度为2mg/l），对呋喃妥因耐药的菌株对呋喃唑酮敏感（呋喃妥因的最低抑菌浓度为4mg/l，呋喃唑酮的最低抑菌浓度为1mg/l）。这4株菌株对甲硝唑耐药（最低抑菌浓度为16mg/l）。在所检测的8株幽门螺杆菌菌株中未检测到呋喃唑酮或呋喃妥因的自发突变株。然而，在所有菌株中均发现了对甲硝唑耐药的突变株，突变率为7.4×10⁻¹⁰至9.4×10⁻¹⁰。呋喃唑酮和呋喃妥因对本文纳入的幽门螺杆菌临床分离株显示出优异的体外活性，支持呋喃唑酮在治疗失败后作为二线抗菌药物或在经济资源有限人群中作为一线治疗药物的有效性。
