Department of gastroenterology, Japan Community Health care Organization Kyoto Kuramaguchi Medical Center, Kyoto, Japan.
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Helicobacter. 2020 Aug;25(4):e12698. doi: 10.1111/hel.12698. Epub 2020 May 5.
Helicobacter pylori (Hp) infection increases the risk of gastric cancer. Therefore, eradication is a global goal, which requires continuous monitoring of therapeutic regimens and effectiveness. Clarithromycin resistance is an important contributor to eradication failure, and metronidazole is recommended as second-line treatment in such cases. Here, we retrospectively evaluated the clarithromycin and metronidazole resistance rates and treatment effectiveness in patients with Hp using tailored therapies according to clarithromycin susceptibility testing.
Data on drug susceptibility were obtained for 5249 Japanese Hp patients between July 2005 and August 2018. Clarithromycin/metronidazole resistance rates were analyzed according to year, gender, and age with Fisher's exact test. The relationship between clarithromycin resistance and Hp therapy outcomes was assessed for 1300 patients. Treatment regimens included a clarithromycin- or metronidazole-containing 7-day triple therapy with one of several proton pump inhibitors and vonoprazan.
Clarithromycin resistance increased annually and was higher in women and younger patients (<30 years). Rates of metronidazole resistance were stable but decreased with age. Hp treatment regimens using PPIs had eradication rates of 88% and 45% among clarithromycin-sensitive and clarithromycin-resistant cases, respectively, while regimens including vonoprazan had eradication rates of around 90% regardless of clarithromycin susceptibility. In particular, triple therapy with vonoprazan, amoxicillin, and metronidazole achieved 98% eradication.
Clarithromycin-containing triple therapy even using vonoprazan did not achieve satisfactory eradication rates even in the clarithromycin-sensitive group. To avoid antibiotic misuse in population with low metronidazole resistance, 7-day vonoprazan, amoxicillin, and metronidazole triple therapy might be a strong candidate as a first-line eradication therapy.
幽门螺杆菌（Hp）感染会增加胃癌的风险。因此，根除 Hp 是全球的目标，这需要不断监测治疗方案和疗效。克拉霉素耐药是根除失败的一个重要因素，在这种情况下，推荐使用甲硝唑作为二线治疗药物。在此，我们根据克拉霉素药敏试验，回顾性评估了采用个体化治疗方案的 Hp 患者的克拉霉素和甲硝唑耐药率及治疗效果。
我们收集了 2005 年 7 月至 2018 年 8 月间 5249 例日本 Hp 患者的药敏数据。采用 Fisher 确切检验，根据年份、性别和年龄分析克拉霉素/甲硝唑耐药率。我们评估了 1300 例患者中克拉霉素耐药与 Hp 治疗结果的关系。治疗方案包括质子泵抑制剂（PPI）联合克拉霉素或甲硝唑的 7 天三联疗法，以及一种或多种含 vonoprazan 的方案。
克拉霉素耐药率逐年上升，女性和年轻患者（<30 岁）的耐药率更高。甲硝唑耐药率保持稳定，但随年龄增长而降低。含 PPI 的 Hp 治疗方案在克拉霉素敏感和耐药患者中的根除率分别为 88%和 45%，而含 vonoprazan 的方案无论克拉霉素是否敏感，根除率均在 90%左右。特别是，含 vonoprazan、阿莫西林和甲硝唑的三联疗法的根除率高达 98%。
即使使用 vonoprazan，含克拉霉素的三联疗法也未能在克拉霉素敏感组中达到令人满意的根除率。为避免甲硝唑耐药率低的人群中抗生素的滥用，7 天 vonoprazan、阿莫西林和甲硝唑三联疗法可能是一线根除治疗的有力候选方案。
