Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.
Helicobacter. 2019 Apr;24(2):e12561. doi: 10.1111/hel.12561. Epub 2019 Jan 10.
The eradication rate of Helicobacter pylori has declined, mainly due to antimicrobial resistance. To overcome resistance-associated treatment failure, the efficacy of culture-based, susceptibility-guided therapy was demonstrated as the first-line eradication therapy for H pylori infection.
To evaluate the efficacy of culture-based therapy as the first-line eradication therapy in regions with high levels of antimicrobial resistance.
Helicobacter pylori-positive patients without previous eradication treatment history were recommended to undergo culture to determine the minimal inhibitory concentration (MIC). If they consented, 7-day clarithromycin-containing PPI triple; 7-day esomeprazole, moxifloxacin, and amoxicillin (MEA) therapy; or 7- or 14-day esomeprazole, bismuth, metronidazole, and tetracycline (quadruple) therapy were administered based on the agar dilution-determined MIC. Eradication, treatment compliance, and adverse events were examined.
In total, 74 patients were enrolled, and 69 patients completed the protocols. The overall resistance rates to amoxicillin, clarithromycin, metronidazole, and moxifloxacin were 6.7%, 31.0%, 41.8%, and 39.2%, respectively. The patients were allocated to the PPI triple (n = 50), MEA (n = 8) or quadruple (n = 16) therapy. The eradication rate in the intention-to-treat analysis was 93.1% (69 of 74 patients). The eradication rates in the per-protocol analysis were 100.0% (69 of 69 patients). Epigastric pain, nausea, and vomiting were less common than those of other empirical therapies.
Culture-based, susceptibility-guided therapy is effective first-line eradication therapy, especially in regions with high levels of antimicrobial resistance.
幽门螺杆菌的根除率下降，主要是由于抗生素耐药性。为了克服与耐药相关的治疗失败，基于培养的药敏指导治疗已被证明是幽门螺杆菌感染的一线根除治疗。
评估在抗生素耐药率较高的地区，基于培养的治疗作为一线根除治疗的疗效。
推荐无既往根除治疗史的幽门螺杆菌阳性患者进行培养以确定最小抑菌浓度（MIC）。如果他们同意，根据琼脂稀释法确定的 MIC，给予 7 天含克拉霉素的质子泵抑制剂三联疗法；7 天埃索美拉唑、莫西沙星和阿莫西林（MEA）疗法；或 7 天或 14 天埃索美拉唑、铋剂、甲硝唑和四环素（四联）疗法。检测根除率、治疗依从性和不良事件。
共纳入 74 例患者，69 例完成方案。阿莫西林、克拉霉素、甲硝唑和莫西沙星的总耐药率分别为 6.7%、31.0%、41.8%和 39.2%。患者被分配至质子泵抑制剂三联疗法（n=50）、MEA（n=8）或四联疗法（n=16）。意向治疗分析的根除率为 93.1%（74 例患者中的 69 例）。按方案分析的根除率为 100.0%（69 例患者中的 69 例）。上腹痛、恶心和呕吐比其他经验性治疗更少见。
基于培养的药敏指导治疗是有效的一线根除治疗，尤其在抗生素耐药率较高的地区。
