Department of Pharmaceutical Microbiology of the Jagiellonian University Medical College, Medyczna 9, PL 30-688 Kraków, Poland.
Pharmacol Rep. 2011;63(3):799-807. doi: 10.1016/s1734-1140(11)70592-8.
The aim of this study was to assess the primary and secondary resistance of H. pylori strains cultured from adult patients of the Małopolska region of Poland, mainly of Kraków and the surrounding areas, to antibacterial agents (amoxicillin, clarithromycin, metronidazole and levofloxacin). In total, 115 H. pylori strains were isolated, of which 90 strains originated from patients who had never been treated for H. pylori infection, while the remaining 25 were isolated from patients in whom eradication of the infection failed after treatment. All tested H. pylori strains were susceptible to amoxicillin. Forty-four percent of strains isolated were resistant to metronidazole. The primary and secondary resistance to this antimicrobial chemotherapeutic reached 37% and 72% (p = 0.002), respectively. In total, 34% of strains were resistant to clarithromycin, and the ratio of strains with secondary resistance was significantly greater than that of the strains with primary resistance (80% vs. 21%, p < 0.001). The double resistance to both metronidazole and clarithromycin was confirmed in 23% of H. pylori strains. Five percent of H. pylori strains were resistant to levofloxacin, while primary and secondary resistance to this drug accounted for 2% and 16% (p = 0.006), respectively. In total, 4% of H. pylori strains were simultaneously resistant to metronidazole, clarithromycin and levofloxacin. Thus, the high resistance to metronidazole and clarithromycin excludes the possibility of using these drugs for treatment of H. pylori infection without earlier antibiogramming. Levofloxacin, as a drug of high efficacy against H. pylori, should be reserved for an "emergency" therapy and used in a limited capacity in order to preserve its potent antimicrobial activity. The Polish Society of Gastroenterology recommends levofloxacin as a third-line therapy.
本研究旨在评估波兰小波兰省成年患者（主要来自克拉科夫及其周边地区）中培养的幽门螺杆菌菌株对抗菌药物（阿莫西林、克拉霉素、甲硝唑和左氧氟沙星）的原发性和继发性耐药性。共分离出 115 株幽门螺杆菌，其中 90 株来自从未接受过幽门螺杆菌感染治疗的患者，其余 25 株来自感染根除治疗失败的患者。所有测试的幽门螺杆菌菌株均对阿莫西林敏感。44%的分离株对甲硝唑耐药。该抗菌化疗药物的原发性和继发性耐药率分别达到 37%和 72%（p = 0.002）。共有 34%的菌株对克拉霉素耐药，且继发性耐药菌株的比例明显高于原发性耐药菌株（80%比 21%，p < 0.001）。在 23%的幽门螺杆菌菌株中证实了对甲硝唑和克拉霉素的双重耐药性。5%的幽门螺杆菌菌株对左氧氟沙星耐药，而该药物的原发性和继发性耐药率分别为 2%和 16%（p = 0.006）。共有 4%的幽门螺杆菌菌株同时对甲硝唑、克拉霉素和左氧氟沙星耐药。因此，甲硝唑和克拉霉素的高耐药性排除了在未进行抗生素药敏试验的情况下使用这些药物治疗幽门螺杆菌感染的可能性。左氧氟沙星作为一种对幽门螺杆菌具有高效作用的药物，应保留用于“紧急”治疗，并在有限的范围内使用，以保持其强大的抗菌活性。波兰胃肠病学会建议将左氧氟沙星作为三线治疗药物。
