Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul.
J Infect Dis. 2013 Oct 1;208(7):1123-30. doi: 10.1093/infdis/jit287. Epub 2013 Jun 24.
Clarithromycin-resistant Helicobacter pylori is associated with point mutations in the 23S ribosomal RNA (rRNA) gene.
A total of 1232 patients participated and were divided into 2 control groups and 1 case group. Patients in the APC control group, which consisted of 308 randomly assigned participants, were treated with standard triple therapy, consisting of amoxicillin, rabeprazole, and clarithromycin; 308 participants in the APM control group were treated with amoxicillin, rabeprazole, and metronidazole. For the 616 participants in the case group, a test for point mutations in the 23S rRNA gene of H. pylori was conducted. A total of 218 individuals in the case group received a new tailored therapy regimen, in which amoxicillin, rabeprazole, and clarithromycin were given in the absence of a mutation, whereas clarithromycin was replaced by metronidazole if the mutation was detected.
The rate of eradication of H. pylori in the tailored group was 91.2% (176/193), which was significantly higher than that in the APC (75.9% [214/282]; P < .001) and APM (79.1% [219/277]; P < .001) control groups.
The rate of H. pylori eradication among patients who received tailored therapy on the basis of detection of a clarithromycin resistance mutation by polymerase chain reaction was much higher than the rate among patients who received a standard triple therapy regimen.
NCT0145303.
克拉霉素耐药的幽门螺杆菌与 23S 核糖体 RNA（rRNA）基因的点突变有关。
共有 1232 名患者参与，分为 2 个对照组和 1 个病例组。APC 对照组（308 名随机分配的参与者）接受标准三联疗法治疗，包括阿莫西林、雷贝拉唑和克拉霉素；APM 对照组（308 名参与者）接受阿莫西林、雷贝拉唑和甲硝唑治疗。对于 616 名病例组的患者，进行了幽门螺杆菌 23S rRNA 基因点突变的检测。病例组中共有 218 人接受了新的个体化治疗方案，在没有突变的情况下给予阿莫西林、雷贝拉唑和克拉霉素，如果检测到突变则用甲硝唑代替克拉霉素。
个体化组的幽门螺杆菌根除率为 91.2%（176/193），明显高于 APC 组（75.9%[214/282]；P<.001）和 APM 组（79.1%[219/277]；P<.001）。
基于聚合酶链反应检测到克拉霉素耐药突变的患者接受个体化治疗的幽门螺杆菌根除率明显高于接受标准三联治疗方案的患者。
NCT0145303。
