Vilaichone Ratha Korn, Quach Duc Trong, Yamaoka Yoshio, Sugano Ken, Mahachai Varocha
Division of Gastroenterology, Department of Medicine, Thammasat University Hospital, Pathumthani, Thailand.
National Gastric Cancer and Gastrointestinal Diseases Research Center, Pathumthani, Thailand. Email:
Asian Pac J Cancer Prev. 2018 May 26;19(5):1411-1413. doi: 10.22034/APJCP.2018.19.5.1411.
Objective: Antibiotic resistance has significantly impact on eradication rates for H. pylori infection and remains important cause of treatment failure worldwide including ASEAN countries. The aim of this study was to survey the prevalence and antibiotic resistant pattern of H. pylori infection in ASEAN. Methods: This study was a survey among 26 experts from 9 ASEAN countries including Thailand, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore and Vietnam whom attended a meeting to develop the ASEAN consensus on H. pylori management in Bangkok in November 2015. A questionnaire was sent to each member of the consensus meeting. The detail of the questionnaire included information about prevalence of H. pylori infection, facilities to perform H. pylori culture, molecular testing for antibiotic resistance and antibiotic resistance rate in their countries. Results: H. pylori infection remain common in ASEAN ranging from 20% in Malaysia, 21-54% in Thailand and 69% in Myanmar. Most of ASEAN countries can perform H. pylori cultures and antibiotic susceptibility tests except Laos and Cambodia. In ASEAN countries, metronidazole resistant H pylori is quite common whereas amoxicillin resistance remain rare. Clarithromycin resistance results in a significant decrease in H. pylori eradication rate with clarithromycin-containing regimens. The prevalence of clarithromycin resistance varies in ASEAN countries being high in Vietnam (30%) and Cambodia (43%), moderate to high in Singapore (17%) and low in Malaysia (6.8%), Philippine (2%) and Myanmar (0%). In Thailand, clarithromycin resistance tends to higher in large cities (14%) than in rural areas (~3.7%). Conclusion: ASEAN countries should develop a standard protocol for regular susceptibility testing of H. pylori so that clinicians would be better able to choose reliably effective empiric therapies. The wide range of antibiotic resistance in ASEAN countries suggests that the preferred first line regimen should be depend on the local antibiotic resistance other than single recommendation.
抗生素耐药性对幽门螺杆菌感染的根除率有显著影响，并且仍是包括东盟国家在内的全球治疗失败的重要原因。本研究的目的是调查东盟地区幽门螺杆菌感染的患病率及抗生素耐药模式。方法：本研究是对来自9个东盟国家（包括泰国、柬埔寨、印度尼西亚、老挝、马来西亚、缅甸、菲律宾、新加坡和越南）的26位专家进行的一项调查，这些专家参加了2015年11月在曼谷召开的关于制定东盟幽门螺杆菌管理共识的会议。向共识会议的每位成员发送了一份问卷。问卷细节包括其所在国家幽门螺杆菌感染的患病率、进行幽门螺杆菌培养的设施、抗生素耐药性的分子检测以及抗生素耐药率等信息。结果：幽门螺杆菌感染在东盟地区仍然普遍，在马来西亚为20%，在泰国为21% - 54%，在缅甸为69%。除老挝和柬埔寨外，大多数东盟国家能够进行幽门螺杆菌培养和抗生素敏感性试验。在东盟国家，甲硝唑耐药的幽门螺杆菌相当常见，而阿莫西林耐药仍然罕见。含克拉霉素方案中克拉霉素耐药导致幽门螺杆菌根除率显著下降。克拉霉素耐药的患病率在东盟国家各不相同，在越南（30%）和柬埔寨（43%）较高，在新加坡中等偏高（17%），在马来西亚（6.8%）、菲律宾（2%）和缅甸（0%）较低。在泰国，大城市的克拉霉素耐药率（14%）往往高于农村地区（约3.7%）。结论：东盟国家应制定幽门螺杆菌常规药敏试验的标准方案，以便临床医生能够更好地选择可靠有效的经验性治疗方法。东盟国家抗生素耐药性的广泛差异表明，首选的一线治疗方案应取决于当地的抗生素耐药情况，而不是单一推荐。
