Mori Hideki, Suzuki Hidekazu, Matsuzaki Juntaro, Masaoka Tatsuhiro, Kanai Takanori
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
United European Gastroenterol J. 2017 Oct;5(6):796-804. doi: 10.1177/2050640616688995. Epub 2017 Jan 19.
() eradication regimen has not been standardized for patients with penicillin allergy. We investigated the association between the efficacy of a 10-day sitafloxacin, metronidazole, and esomeprazole triple regimen and antibiotic resistance, in patients with penicillin allergy.
Penicillin-allergic patients infected with were enrolled between March 2014 and November 2015. The minimum inhibitory concentrations (MICs) of sitafloxacin and metronidazole, and the mutation status of the strains were determined before treatment. The cut-off points for antimicrobial resistance were defined as 8.0 µg/ml for metronidazole and 0.12 µg/ml for sitafloxacin. The patients received the triple therapy (20 mg esomeprazole, bid; 250 mg metronidazole, bid; and 100 mg sitafloxacin, bid) for 10 days. Successful eradication was evaluated using the [C] urea breath test or the stool antigen test.
Fifty-seven patients were analyzed, and the overall eradication rate was 89.5%. The eradication rate in cases of double antibiotic resistance to metronidazole and sitafloxacin was 40.0%, whereas for other combinations of resistance, this was above 90.0%. Finally, the eradication rate of mutation-negative strains was 96.2%, whereas for mutation-positive strains, it was 83.9%. Adverse events were reported in 31.6% of cases, all of which were mild and tolerable.
Ten days of sitafloxacin and metronidazole triple therapy was safe and highly effective in eradicating in penicillin-allergic patients. Double resistance to metronidazole and sitafloxacin was an important predicting factor for eradication failure. However, 10 days of the sitafloxacin and metronidazole triple therapy was highly effective if the strain was susceptible to either sitafloxacin or metronidazole.
青霉素过敏患者的根除治疗方案尚未标准化。我们调查了青霉素过敏患者中，为期10天的西他沙星、甲硝唑和埃索美拉唑三联疗法的疗效与抗生素耐药性之间的关联。
2014年3月至2015年11月纳入青霉素过敏且感染[具体病菌名称未给出]的患者。治疗前测定西他沙星和甲硝唑的最低抑菌浓度（MICs）以及[具体病菌名称未给出]菌株的[具体基因突变名称未给出]突变状态。甲硝唑和西他沙星的抗菌耐药性临界值分别定义为8.0μg/ml和0.12μg/ml。患者接受三联疗法（20mg埃索美拉唑，每日两次；250mg甲硝唑，每日两次；100mg西他沙星，每日两次），疗程为10天。采用[C]尿素呼气试验或[具体病菌名称未给出]粪便抗原试验评估根除是否成功。
共分析57例患者，总体根除率为89.5%。对甲硝唑和西他沙星双重耐药的病例根除率为40.0%，而其他耐药组合的根除率高于90.0%。最后，[具体基因突变名称未给出]突变阴性菌株的根除率为96.2%，而[具体基因突变名称未给出]突变阳性菌株的根除率为83.9%。31.6%的病例报告了不良事件，均为轻度且可耐受。
为期10天的西他沙星和甲硝唑三联疗法在根除青霉素过敏患者的[具体病菌名称未给出]方面安全且高效。对甲硝唑和西他沙星双重耐药是根除失败的重要预测因素。然而，如果菌株对西他沙星或甲硝唑敏感，为期10天的西他沙星和甲硝唑三联疗法非常有效。
