Yakoob J, Abid S, Abbas Z, Jafri S N W
Department of Medicine, The Aga Khan University, Karachi, Pakistan.
Br J Biomed Sci. 2010;67(4):197-201. doi: 10.1080/09674845.2010.11730319.
This study aims to determine primary Helicobacter pylori resistance and its effect on eradication of the organism. Ninety-two patients with dyspeptic symptoms were enrolled. H. pylori was cultured and antibiotic sensitivity was determined by the Epsilometer test (Etest) for clarithromycin (CLR), amoxicillin (AMX) and metronidazole (MTR). 23S ribosomal RNA (rRNA) point mutations associated with clarithromycin resistance were also detected. Patients were treated with omeprazole (40 mg daily), CLR (500 mg) and AMX (1g twice a day) for 14 days. A 14C-urea breath test (14C-UBT) was repeated four weeks after completion of treatment to confirm eradication. Triple therapy failure was seen in 30 (33%) patients. The resistance rates were: CLR 33% (30/92), MTR 48% (44/92) and AMX 2% (2/92). Clarithromycin resistance (CLR-R) was present in the 16-39 age group in 21 (47%) (P = 0.007) compared to nine (19%) in the 40-79 age group. CLR resistance was seen in 30 H. pylori isolates, 20 (67%) from patients with non-ulcer dyspepsia (NUD), six (20%) with gastric ulcer (GU) and four (13%) with duodenal ulcer (DU). Triple therapy failure was associated with CLR-R in 28 (93%) (P < 0.001). CLR-R mutations were present in 30 (33%) and were associated with treatment failure in 27 (90%; P < 0.001). They were present in 20 (44%) isolates obtained from patients in the 16-39 age group (P = 0.018). Treatment failure was associated with A2142G mutation in 20 (67%; P < 0.001), A2143G mutation in 12 (40%; P < 0.001) and A2142C mutation in five (17%; P = 0.003). In conclusion, triple therapy failure was associated with CLR-R. Metronidazole resistance exceeded that of CLR, hence it cannot be substituted for CLR in a triple therapy.
本研究旨在确定原发性幽门螺杆菌耐药性及其对该菌根除的影响。纳入了92例有消化不良症状的患者。培养幽门螺杆菌，并通过Epsilometer试验（Etest）测定对克拉霉素（CLR）、阿莫西林（AMX）和甲硝唑（MTR）的抗生素敏感性。还检测了与克拉霉素耐药相关的23S核糖体RNA（rRNA）点突变。患者接受奥美拉唑（每日40 mg）、CLR（500 mg）和AMX（每日2次，每次1 g）治疗14天。治疗结束4周后重复进行14C-尿素呼气试验（14C-UBT）以确认根除情况。30例（33%）患者三联疗法失败。耐药率分别为：CLR 33%（30/92），MTR 48%（44/92），AMX 2%（2/92）。16 - 39岁年龄组中21例（47%）存在克拉霉素耐药（CLR-R）（P = 0.007），而40 - 79岁年龄组中为9例（19%）。在30株幽门螺杆菌分离株中发现CLR耐药，其中20株（67%）来自非溃疡性消化不良（NUD）患者，6株（20%）来自胃溃疡（GU）患者，4株（13%）来自十二指肠溃疡（DU）患者。28例（93%）三联疗法失败与CLR-R相关（P < 0.001）。30例（33%）存在CLR-R突变，其中27例（90%；P < 0.001）与治疗失败相关。在16 - 39岁年龄组患者分离出的20株（44%）菌株中存在这些突变（P = 0.018）。治疗失败与A2142G突变相关的有20例（67%；P < 0.001），与A2143G突变相关的有12例（40%；P < 0.001），与A2142C突变相关的有5例（17%；P = 0.003）。总之，三联疗法失败与CLR-R相关。甲硝唑耐药率超过克拉霉素，因此在三联疗法中不能用其替代克拉霉素。
