Comparative effects of omeprazole, amoxycillin plus metronidazole versus omeprazole, clarithromycin plus metronidazole on the oral, gastric and intestinal microflora in Helicobacter pylori-infected patients
Comparative effects of omeprazole, amoxycillin plus metronidazole versus omeprazole, clarithromycin plus metronidazole on the oral, gastric and intestinal microflora in Helicobacter pylori-infected patients
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DOI：
10.1093/jac/44.5.629
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发表时间：
1999-11-01
影响因子：
5.2
通讯作者：
Edlund, C
中科院分区：
文献类型：
--
作者：
Adamsson, I;Nord, CE;Edlund, C
14例幽门螺杆菌感染患者用奥美拉唑20 mg+阿莫西林1 g+甲硝唑400 mg bd治疗7 d（OAM），16例用奥美拉唑20 mg+克拉霉素250 mg+甲硝唑400 mg bd治疗7 d（OCM）。唾液，胃活检和粪便样本收集前，期间（第7天）和治疗后4周，以分析正常微生物菌群的变化，并确定抗菌药物的敏感性。两种治疗方案均导致显著的定量和定性变化。在两个治疗组中都注意到了一系列耐药链球菌菌株，其中在OCM组中最为明显，记录了从敏感菌株到耐药菌株的转变。在OAM组中，6名患者在治疗期间在胃微生物区系中出现耐药肠杆菌科细菌过度生长，而OCM组中没有。肠球菌属的MIC。两组治疗期间粪便中肠杆菌和肠杆菌均显著增加。OAM组中的9名患者在治疗期间被酵母菌定植。在两个治疗组中，总厌氧微生物菌群均受到强烈抑制，但在OCM组中最明显，其中克拉霉素耐药类杆菌菌株的频率在治疗期间从2%增加至76%，并在治疗后4周保持在59%。即使OCM组（100%）的治疗结局优于OAM组（71%），从生态学角度来看，基于阿莫西林的治疗可能更可取，因为克拉霉素治疗组中耐药菌株出现和持续性方面的质的变化似乎最明显。
Fourteen patients with Helicobacter pylori infection were treated with 20 mg omeprazole, 1 g amoxycillin and 400 mg metronidazole bd for 7 days (OAM), and 16 patients were treated with 20 mg omeprazole, 250 mg clarithromycin and 400 mg metronidazole bd for 7 days (OCM). Saliva, gastric biopsies and faecal samples were collected before, during (day 7) and 4 weeks after treatment in order to analyse alterations of the normal microflora and to determine antimicrobial susceptibility. Both treatment regimens resulted in marked quantitative and qualitative alterations. A selection of resistant streptococcal strains were noticed in both treatment groups, most apparent in the OCM group where a shift from susceptible to resistant strains was recorded. In the OAM group, six patients had overgrowth of resistant Enterobacteriaceae during treatment compared with none in the OCM group, in the gastric microflora. The MICs for Enterococcus spp. and Enterobacteriaceae in faeces increased significantly during treatment in both groups. Nine patients in the OAM group became intestinally colonized by yeasts during treatment. The total anaerobic microflora was strongly suppressed in both treatment groups, although most pronounced in the OCM group, where the frequency of clarithromycin-resistant bacteroides strains increased from 2 to 76% during treatment, and remained at 59% 4 weeks post-treatment. Even if the treatment outcome was better in the OCM group (100%) than in the OAM group (71%), the amoxycillin-based treatment might be preferable from an ecological point of view, since the qualitative alterations in terms of emergence and persistence of resistant strains seemed to be most pronounced in the clarithromycin-treated group.