Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
J Gastroenterol Hepatol. 2019 Apr;34(4):666-672. doi: 10.1111/jgh.14625. Epub 2019 Feb 25.
Failure of bismuth quadruple therapy for Helicobacter pylori eradication is frequently observed. To increase the eradication rate, comprehensive analyses need to be performed regarding risk factors of bismuth quadruple therapy failure based on complete standard culture and antimicrobial susceptibility testing results.
Patients with history of failed first therapy who had H. pylori colonies isolated from culture and successful minimum inhibitory concentration (MIC) test were enrolled. Esomeprazole, bismuth, metronidazole, and tetracycline (quadruple) therapies for 7 or 14 days were given. Eradication rate, treatment compliance, adverse events, and risk factors for the failure of bismuth quadruple therapy were analyzed.
A total 54 patients were enrolled. Overall eradication rate in the present study was 88.8%. The eradication rate for cases with metronidazole resistance such as MIC 8-16 μg/mL or 16-32 μg/mL was 92.8% (13/14). For cases with high level metronidazole resistance (MIC > 32 μg/mL), the eradication rate was only 60% (6/10). Multivariate analysis regarding compliance, treatment duration, age > 60, three kinds of metronidazole MICs, tetracycline MIC > 4 μg/mL, adverse events and any other parameters, "metronidazole resistance, high level (MIC > 32 μg/mL)" was the only independent risk factor for eradication failure (P = 0.007).
For cases with metronidazole resistance at MIC > 32 μg/mL, rescue therapy other than bismuth-containing quadruple therapy is needed.
铋四联疗法治疗幽门螺杆菌失败的情况经常发生。为了提高根除率，需要基于完整的标准培养和抗菌药物敏感性检测结果，对铋四联疗法失败的危险因素进行综合分析。
纳入首次治疗失败且从培养物中分离出幽门螺杆菌菌落并成功进行最小抑菌浓度（MIC）检测的患者。给予埃索美拉唑、铋、甲硝唑和四环素（四联）治疗 7 或 14 天。分析根除率、治疗依从性、不良反应以及铋四联疗法失败的危险因素。
共纳入 54 例患者。本研究的总体根除率为 88.8%。对于 MIC 8-16μg/mL 或 16-32μg/mL 的甲硝唑耐药病例，根除率为 92.8%（13/14）。对于高水平甲硝唑耐药（MIC>32μg/mL）的病例，根除率仅为 60%（6/10）。关于依从性、治疗持续时间、年龄>60 岁、三种甲硝唑 MIC 值、四环素 MIC>4μg/mL、不良反应和任何其他参数的多变量分析，“甲硝唑耐药，高水平（MIC>32μg/mL）”是根除失败的唯一独立危险因素（P=0.007）。
对于 MIC>32μg/mL 的甲硝唑耐药病例，需要使用除铋四联疗法以外的补救治疗。
