Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou, 5, Fushin Street, Kweishan, Taoyuan, Taiwan, Republic of China, 333.
Chang Gung University, College of Medicine, Taoyuan, Taiwan.
BMC Gastroenterol. 2020 Jul 10;20(1):218. doi: 10.1186/s12876-020-01370-4.
There is no current standard rescue treatment for dual drug-resistant strains of Helicobacter pylori (H. pylori). This aim of this study was to investigate the efficacy of rifabutin-based triple therapy for patients infected with dual drug-resistant strains to clarithromycin and levofloxacin.
After 2 or 3 H. pylori treatment failures, patients underwent upper endoscopy with tissue biopsies. Phenotypic and genotypic resistances were determined using agar dilution test and polymerase chain reaction with direct sequencing, respectively. Patients infected with dual drug-resistant (clarithromycin and levofloxacin) strains and receiving rifabutin-based triple therapy (rifabutin 150 mg bid, amoxicillin 1 g bid and esomeprazole 40 mg bid for 10 days) were enrolled. Eradication status was determined by 13C-urea breath test 4 weeks after treatment completion.
A total of 39 patients infected with dual drug-resistant strains were enrolled in this study, with a mean age of 55.9 years. The eradication rate was 79.5% (31/39) (95% confidence intervals: 54.96% ~ 111.40%). Adverse event was reported in 23.1% (9/39) of patients but they were mild and tolerable. In univariate analysis, no factor was identified as an independent predictor of eradication failure.
Our current study demonstrated that rifabutin-based triple therapy was well tolerated and yielded an acceptable eradication rate for patients infected with dual drug-resistant strains of H. pylori.
目前尚无针对幽门螺杆菌（H. pylori）双重耐药菌株的标准抢救治疗方法。本研究旨在探讨利福布汀三联疗法治疗克拉霉素和左氧氟沙星双重耐药菌株感染患者的疗效。
在经历了 2 或 3 次 H. pylori 治疗失败后，患者接受了上内窥镜检查和组织活检。采用琼脂稀释法和聚合酶链反应直接测序法分别进行表型和基因型耐药性测定。纳入接受利福布汀三联疗法（利福布汀 150mg bid、阿莫西林 1g bid 和埃索美拉唑 40mg bid，疗程 10 天）治疗且感染双重耐药（克拉霉素和左氧氟沙星）菌株的患者。治疗结束后 4 周，通过 13C-尿素呼气试验确定根除情况。
本研究共纳入 39 例感染双重耐药菌株的患者，平均年龄为 55.9 岁。根除率为 79.5%（31/39）（95%置信区间：54.96%~111.40%）。23.1%（9/39）的患者报告了不良反应，但均为轻度且可耐受。单因素分析未发现根除失败的独立预测因素。
本研究表明，利福布汀三联疗法耐受性良好，对感染双重耐药 H. pylori 菌株的患者具有可接受的根除率。
