Department of Internal Medicine, St. Vincent Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea.
Helicobacter. 2021 Jun;26(3):e12792. doi: 10.1111/hel.12792. Epub 2021 Mar 1.
Addressing the increasing antibiotic resistance, including clarithromycin resistance, which affects Helicobacter pylori eradication therapy, is a challenge for clinicians. The objective of this study was to determine the efficacy of bismuth added to standard triple therapy as a first-line treatment regimen for Helicobacter pylori infection. The secondary outcome was the treatment efficacy for clarithromycin-resistant strains.
A prospective study was undertaken from January to December 2019. A total of 107 patients with Helicobacter pylori infection were enrolled and received Helicobacter pylori eradication therapy with bismuth added to standard triple therapy for 14 days. We also evaluated the clarithromycin resistance rate by dual-priming oligonucleotide-based multiplex PCR and treatment efficacy.
A total of 104 patients completed standard triple therapy with bismuth added for Helicobacter pylori eradication. The eradication rates in the intention to treat and per-protocol analyses were 87.9% and 90.4%, respectively. The frequency of clarithromycin resistance was 33.6% (35/104), and the eradication rate was 77.1% in resistant strains (27/35).
Bismuth added to standard triple therapy could be acceptable as a first-line treatment regimen for Helicobacter pylori eradication in patients with clarithromycin-resistant strains. In particular, in areas with high clarithromycin tolerance, it is advisable to consider bismuth add-on therapy as the first-line treatment regimen.
包括克拉霉素耐药在内的抗生素耐药性日益增加，这对临床医生来说是一个挑战。本研究的目的是确定在标准三联疗法的基础上加用铋剂作为一线治疗方案治疗幽门螺杆菌感染的疗效。次要结局是治疗克拉霉素耐药菌株的疗效。
本前瞻性研究于 2019 年 1 月至 12 月进行。共纳入 107 例幽门螺杆菌感染患者，接受标准三联疗法加用铋剂治疗 14 天。我们还通过双重引物寡核苷酸多重 PCR 评估克拉霉素耐药率和治疗效果。
共有 104 例患者完成了标准三联疗法加铋剂治疗幽门螺杆菌的根除。意向治疗和符合方案分析的根除率分别为 87.9%和 90.4%。克拉霉素耐药率为 33.6%（35/104），耐药菌株的根除率为 77.1%（27/35）。
在克拉霉素耐药的患者中，标准三联疗法加用铋剂可作为幽门螺杆菌根除的一线治疗方案。特别是在克拉霉素耐药率较高的地区，建议将铋剂加用治疗作为一线治疗方案。
