Ferenc Stanisław, Gnus Jan, Kościelna Magdalena, Kinda Małgorzata, Yarka Andriy, Stewart Luke, Witkiewicz Wojciech
Department of General Surgery, Regional Specialist Hospital in Wroclaw, Wroclaw, Poland.
Research and Development Centre, Regional Specialist Hospital in Wroclaw, Wroclaw, Poland.
Helicobacter. 2017 Apr;22(2). doi: 10.1111/hel.12365. Epub 2016 Nov 23.
At present, the resistance to antibiotics is considered the most important reason for Helicobacter pylori (HP) eradication failure. The aim of this study was to estimate the prevalence of antimicrobial resistance of HP strains and to evaluate tailored and empiric therapeutic regimens in patients with peptic ulcer disease associated with infection of this microorganism.
Between May 2011 and February 2013, 185 consecutive Polish patients with at least one positive Helicobacter pylori test (urease test, histopathologic examination, and/or culture) underwent eradication therapy. Those with positive culture were prescribed a tailored triple regimen, whereas those with no culture available received an empiric quadruple concomitant regimen or levofloxacin-containing triple therapy.
There were no HP strains resistant to amoxicillin; however, 56.7% were resistant to metronidazole, 55.2% to clarithromycin, and 5.9% to levofloxacin. Dual resistance was detected in 32.8% of individuals. Tailored and empiric therapies achieve cure rates, respectively, 95.5% and 86.6% by intention-to-treat and 95.5% and 91.3% by per-protocol analysis (P > 0.05).
Antibiotic resistance is notably high in Poland currently, but both tailored and empiric therapies can achieve acceptable cure rates equal to or higher than 90%.
目前，抗生素耐药性被认为是幽门螺杆菌（HP）根除失败的最重要原因。本研究的目的是评估HP菌株的抗菌药物耐药性流行情况，并评估针对感染该微生物的消化性溃疡疾病患者的个体化和经验性治疗方案。
2011年5月至2013年2月期间，185例连续的波兰患者，其至少一项幽门螺杆菌检测（尿素酶试验、组织病理学检查和/或培养）呈阳性，接受了根除治疗。培养阳性的患者采用个体化三联疗法，而无法进行培养的患者接受经验性四联联合疗法或含左氧氟沙星的三联疗法。
没有HP菌株对阿莫西林耐药；然而，56.7%对甲硝唑耐药，55.2%对克拉霉素耐药，5.9%对左氧氟沙星耐药。32.8%的个体检测到双重耐药。个体化治疗和经验性治疗的意向性治疗治愈率分别为95.5%和86.6%，按方案分析治愈率分别为95.5%和91.3%（P>0.05）。
目前在波兰抗生素耐药性明显较高，但个体化治疗和经验性治疗均可达到等于或高于90%的可接受治愈率。
