Le Loan T T, Nguyen Tuan A, Nguyen Nghia A, Nguyen Yen T H, Nguyen Hai T B, Nguyen Liem T, Vi Mai T, Nguyen Thang
Department of Pediatrics, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam.
Department of Pediatrics, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam.
Children (Basel). 2022 Jul 8;9(7):1019. doi: 10.3390/children9071019.
The efficacy of () eradication therapy for children is currently low, and antibiotic resistance is a significant cause of treatment failure. The purpose of this study was to evaluate the eradication efficacy of therapy based on antimicrobial susceptibility in pediatric patients with gastritis and peptic ulcer.
This study was conducted at Can Tho Children's Hospital and Can Tho University of Medicine and Pharmacy Hospital between March 2019 and April 2022. We performed an upper gastrointestinal endoscopy, cultured from biopsies of gastric mucosa, determined antibiotic sensitivities to by the E-test method, and treated eradication based on the antibiotic susceptibilities of bacteria. After at least 4 weeks of eradication therapy, we assessed the effectiveness of treatment with a breath test.
Among 237 children recruited in this study, 48.9% were boys and 51.1% were girls, and the mean age was 10.03 ± 2.53 years. We determined that 80.6% of were resistant to clarithromycin, as well as amoxicillin, metronidazole, levofloxacin, and tetracycline, at 71.7%, 49.4%, 45.1%, and 11.4%, respectively. The overall eradication rate of was 83.1% (172/207). Among therapies tailored to antimicrobial susceptibility, the bismuth quadruple regimen achieved the greatest success, but the efficacy of triple therapy with esomeprazole + AMX + CLR/MTZ was low.
Tailored eradication therapy was highly successful in our study but did not achieve over 90%. We recommend that in countries with a high prevalence of antibiotic resistance in strains, particularly where the amoxicillin-resistance rate of is high, therapy tailored to antimicrobial susceptibility should be used as first-line therapy, and bismuth and tetracycline should be added to enhance the eradication efficacy in children.
目前儿童幽门螺杆菌根除治疗的疗效较低，抗生素耐药是治疗失败的重要原因。本研究旨在评估基于抗菌药物敏感性的治疗方案对小儿胃炎和消化性溃疡患者幽门螺杆菌的根除疗效。
本研究于2019年3月至2022年4月在芹苴儿童医院和芹苴医药大学医院进行。我们进行了上消化道内镜检查，从胃黏膜活检组织中培养幽门螺杆菌，采用E-test法测定其对各种抗生素的敏感性，并根据细菌的抗生素敏感性进行根除治疗。在至少4周的根除治疗后，我们通过呼气试验评估治疗效果。
本研究共纳入237名儿童，其中48.9%为男孩，51.1%为女孩，平均年龄为10.03±2.53岁。我们发现，80.6%的幽门螺杆菌对克拉霉素耐药，对阿莫西林、甲硝唑、左氧氟沙星和四环素的耐药率分别为71.7%、49.4%、45.1%和11.4%。幽门螺杆菌的总体根除率为83.1%（172/207）。在根据抗菌药物敏感性制定的治疗方案中，铋剂四联疗法取得了最大的成功，但埃索美拉唑+阿莫西林+克拉霉素/甲硝唑三联疗法的疗效较低。
在我们的研究中，个体化根除治疗取得了很高的成功率，但未超过90%。我们建议，在幽门螺杆菌菌株抗生素耐药率较高的国家，特别是阿莫西林耐药率较高的地区，应将根据抗菌药物敏感性制定的治疗方案作为一线治疗方案，并添加铋剂和四环素以提高儿童的根除疗效。
