Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
J Antimicrob Chemother. 2017 Dec 1;72(12):3481-3489. doi: 10.1093/jac/dkx320.
The impact of amoxicillin resistance on the efficacy of regimens containing amoxicillin for Helicobacter pylori eradication remains unknown.
To investigate whether the efficacy of an amoxicillin-containing regimen is affected by amoxicillin resistance and to identify the optimal breakpoint for amoxicillin resistance.
This was a pooled analysis of five randomized trials conducted in Taiwan from 2007 to 2016. Patients who received amoxicillin-containing regimens were recruited. MICs were determined by agar dilution testing. Meta-analysis was performed to assess the risk ratio of eradication failure in amoxicillin-resistant strains compared with susceptible strains of seven different regimens. We performed further the pooled analysis and logistic regression in patients treated with clarithromycin triple therapy to identify the optimal breakpoint for amoxicillin resistance.
A total of 2339 patients with available amoxicillin MICs were enrolled. Meta-analysis showed that the presence of amoxicillin resistance was consistently associated with increased risk of treatment failure of amoxicillin-containing regimens at different breakpoints (risk ratio: 1.41, 95% CI 1.12-1.78, P = 0.004 when the cut-off was 0.5 mg/L). The heterogeneity was low (I2 = 0%, P = 0.615). Pooled analysis also showed that amoxicillin resistance was an independent risk factor for treatment failure of clarithromycin triple therapy at different breakpoints. The best correlation was observed when the breakpoint of amoxicillin resistance was ≥0.125 mg/L (kappa coefficient 0.298), at which the resistance rate was 11.1% (110 of 990).
The efficacies of amoxicillin-containing regimens are affected by amoxicillin resistance and the optimal breakpoint MIC is ≥ 0.125 mg/L.
阿莫西林耐药对含阿莫西林方案根除幽门螺杆菌疗效的影响尚不清楚。
研究含阿莫西林方案的疗效是否受阿莫西林耐药影响，并确定阿莫西林耐药的最佳折点。
这是 2007 年至 2016 年在台湾进行的五项随机试验的汇总分析。招募接受含阿莫西林方案治疗的患者。采用琼脂稀释法测定 MIC。采用荟萃分析评估 7 种不同方案中耐药株与敏感株根除失败的风险比。我们进一步对接受克拉霉素三联疗法治疗的患者进行汇总分析和逻辑回归，以确定阿莫西林耐药的最佳折点。
共纳入 2339 例可获得阿莫西林 MIC 值的患者。荟萃分析显示，不同折点的阿莫西林耐药均与含阿莫西林方案治疗失败的风险增加相关（风险比：1.41，95%CI 1.12-1.78，P=0.004，当截止值为 0.5mg/L 时）。异质性低（I2=0%，P=0.615）。汇总分析还显示，阿莫西林耐药是克拉霉素三联疗法治疗失败的独立危险因素，在不同折点均如此。当阿莫西林耐药的折点为≥0.125mg/L 时，相关性最佳（kappa 系数 0.298），此时耐药率为 11.1%（110/990）。
含阿莫西林方案的疗效受阿莫西林耐药影响，最佳折点 MIC 值为≥0.125mg/L。
