Choi Soo Yeon, Lim Na Rae, Chung Woo Chul
Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
Korean J Helicobacter Up Gastrointest Res. 2023 Jun;23(2):118-124. doi: 10.7704/kjhugr.2022.0058. Epub 2023 Apr 10.
BACKGROUND/AIMS: Compared with other regimens, concomitant therapy (CT) used as a first-line regimen for infection is associated with higher eradication rates. We compared the efficacy of tailored therapy (TT) using bismuth added to standard triple therapy (STT) with CT.
This consecutive study performed between September 2020 and 2021 included 210 patients with infection. Two participating gastroenterologists prescribed TT and CT. Multiplex PCR assays were performed before eradication therapy to identify the relevant point mutations and confirm clarithromycin resistance in the TT group (n=105). Patients who showed negative PCR results received 14-day STT and those with positive PCR results received a 14-day regimen of bismuth added to STT. The other group (n=105) received 10-day CT.
Based on per-protocol analysis, eradication rates in the TT and CT groups were 89.2% (91/102) and 81.6% (84/103), respectively. We observed no statistically significant intergroup differences in eradication rates (=0.12). The frequency of estimated clarithromycin resistance confirmed using multiplex PCR assays was 32.4% (34/105), and the eradication rate associated with bismuth add-on STT was 76.5% (26/34) in patients with clarithromycin resistance.
Considering the current and emerging trends in antibiotic resistance, a therapeutic strategy using TT (bismuth add-on STT) is recommended to minimize unnecessary administration of antibiotics.
背景/目的：与其他治疗方案相比，作为 感染一线治疗方案的联合疗法（CT）具有更高的根除率。我们比较了在标准三联疗法（STT）中添加铋剂的个体化疗法（TT）与 CT 的疗效。
这项在 2020 年 9 月至 2021 年期间进行的连续性研究纳入了 210 例 感染患者。两名参与研究的胃肠病学家分别开出 TT 和 CT 方案。在根除治疗前进行多重 PCR 检测，以识别 TT 组（n = 105）中的相关点突变并确认克拉霉素耐药性。PCR 结果为阴性的患者接受 14 天的 STT，PCR 结果为阳性的患者接受在 STT 基础上加用铋剂的 14 天治疗方案。另一组（n = 105）接受 10 天的 CT。
根据符合方案分析，TT 组和 CT 组的根除率分别为 89.2%（91/102）和 81.6%（84/103）。我们观察到两组根除率之间无统计学显著差异（P = 0.12）。使用多重 PCR 检测确认的估计克拉霉素耐药频率为 32.4%（34/105），在克拉霉素耐药患者中，加用铋剂的 STT 的根除率为 76.5%（26/34）。
考虑到当前和新出现的抗生素耐药趋势，建议采用 TT（加用铋剂的 STT）治疗策略，以尽量减少不必要的抗生素使用。
