Resina Elena, Gisbert Javier P
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Gastroenterology Unit, Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM), 28049 Madrid, Spain.
Antibiotics (Basel). 2021 Aug 24;10(9):1028. doi: 10.3390/antibiotics10091028.
infection may persist after multiple eradication treatments. The aim of this study was to evaluate the efficacy and safety of a furazolidone-based rescue regimen in hyper-refractory patients. A unicentre, prospective study was designed. Patients in whom five or more treatments had consecutively failed were included. All patients had previously received bismuth and key antibiotics, such as amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, and rifabutin, and had positive culture, demonstrating resistance to clarithromycin, metronidazole, and levofloxacin. A quadruple regimen with furazolidone (200 mg), amoxicillin (1 g), bismuth (240 mg), and esomeprazole (40 mg) was prescribed twice a day for 14 days. Eradication was confirmed by the stool antigen test. Compliance was determined through questioning, and adverse effects using a questionnaire. Eight patients (mean age 56 years, 63% men, 38% peptic ulcer disease, 12% gastric cancer precursor lesions, and 50% functional dyspepsia) were included. Per-protocol and intention-to-treat eradication rates were 63%. Compliance was 100%. Adverse effects were reported in two (25%) patients, and all were mild. Even after five or more previous eradication failures, and a multi-resistant infection, rescue treatment with furazolidone may be effective in approximately two-thirds of the cases, constituting a valid strategy after multiple previous eradication failures with key antibiotics such as clarithromycin, metronidazole, tetracycline, levofloxacin, and rifabutin.
多次根除治疗后感染仍可能持续。本研究的目的是评估基于呋喃唑酮的挽救方案对超难治性患者的疗效和安全性。设计了一项单中心前瞻性研究。纳入连续五次或更多次治疗失败的患者。所有患者此前均接受过铋剂和关键抗生素治疗，如阿莫西林、克拉霉素、甲硝唑、左氧氟沙星、四环素和利福布汀，且培养结果呈阳性，显示对克拉霉素、甲硝唑和左氧氟沙星耐药。给予含呋喃唑酮（200毫克）、阿莫西林（1克）、铋剂（240毫克）和埃索美拉唑（40毫克）的四联方案，每天服用两次，共14天。通过粪便抗原检测确认根除情况。通过询问确定依从性，并使用问卷评估不良反应。纳入了8名患者（平均年龄56岁，男性占63%，消化性溃疡疾病占38%，胃癌前病变占12%，功能性消化不良占50%）。符合方案和意向性分析的根除率均为63%。依从性为100%。两名（25%）患者报告了不良反应，均为轻度。即使在之前五次或更多次根除失败以及多重耐药感染后，使用呋喃唑酮进行挽救治疗在大约三分之二的病例中可能有效，这是在之前使用克拉霉素、甲硝唑、四环素、左氧氟沙星和利福布汀等关键抗生素多次根除失败后的一种有效策略。
