Internal Medicine Departament, Parc Taulí University Sanitary Corporation, Sabadell, Spain.
Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
Helicobacter. 2019 Jun;24(3):e12584. doi: 10.1111/hel.12584. Epub 2019 Apr 16.
Susceptibility-guided treatment has been proposed as a way to improve Helicobacter pylori eradication rates. Evidence on its efficacy for rescue therapy is very scarce. The aim of this study was to indirectly assess the applicability and effectiveness of susceptibility-guided treatment by evaluating (a) the rate of acceptance of endoscopy, (b) its success in detecting resistances, and (c) infection cure rates in patients harboring strains found to be susceptible to the antibiotics administered in clinical trials in which the efficacy of second-line treatments was reported.
A systematic review of studies evaluating second-line H pylori treatment was carried out in multiple databases. Studies reporting antibiotic susceptibility evaluation and/or cure rates in patients harboring sensitive and resistant strains were selected. Data were extracted in duplicate.
The systematic review identified 36 eligible studies. Acceptance was evaluated in only one study of 60 patients, of whom only 38 agreed to endoscopy. Among the 2890 patients who received endoscopy and culture, resistances were finally determined in 86.5%. Cure rate was 72.5% in the 113 patients harboring a clarithromycin-susceptible strain after previous clarithromycin treatment, 93.5% in the 765 patients harboring a metronidazole-susceptible strain, and 83.8% in the 192 patients harboring a levofloxacin-susceptible strain. No studies with repeated administration of levofloxacin or metronidazole were found.
Even if the culture shows a clarithromycin-sensitive strain, repeating clarithromycin after a first failure should be discouraged. Susceptibility-guided treatment alone did not achieve adequate cure rates for rescue therapies. Additional measures are needed to design rescue treatments that consistently achieve excellent cure rates.
敏感性指导治疗被提议作为提高幽门螺杆菌根除率的一种方法。关于其在补救治疗中的疗效的证据非常有限。本研究的目的是通过评估（a）接受内镜检查的比例，（b）检测耐药性的成功率，以及（c）在临床试验中报告二线治疗疗效的抗生素治疗中发现敏感菌株的患者的感染治愈率，间接地评估敏感性指导治疗的适用性和有效性。
在多个数据库中进行了评估二线 H pylori 治疗的系统评价。选择了报告抗生素敏感性评估和/或在携带敏感和耐药菌株的患者中治愈率的研究。数据由两人重复提取。
系统评价确定了 36 项合格研究。仅在一项 60 例患者的研究中评估了接受程度，其中只有 38 例同意接受内镜检查。在接受内镜检查和培养的 2890 例患者中，最终确定了 86.5%的耐药性。在 113 例先前接受克拉霉素治疗且克拉霉素敏感的患者中，治愈率为 72.5%，在 765 例甲硝唑敏感的患者中，治愈率为 93.5%，在 192 例左氧氟沙星敏感的患者中，治愈率为 83.8%。未发现重复使用左氧氟沙星或甲硝唑的研究。
即使培养显示克拉霉素敏感菌株，也不应该鼓励在首次失败后重复使用克拉霉素。单独的敏感性指导治疗未能达到补救治疗的充分治愈率。需要采取额外措施来设计始终能达到优异治愈率的补救治疗。
