Call for shift in Helicobacter pylori treatment
Call for shift in Helicobacter pylori treatment
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呼吁改变幽门螺杆菌治疗
DOI：
10.1097/meg.0000000000001096
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发表时间：
2018
影响因子：
2.1
通讯作者：
Yamaoka Yoshio
中科院分区：
文献类型：
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作者：
Talebi Bezmin Abadi Amin;Yamaoka Yoshio
我们饶有兴趣地阅读了Costa等人的文章。[1]研究培养导向法检测幽门螺杆菌（H. pylori，H. pylori）感染。除了作者报告的非常有趣的发现之外，还有一些评论改进了目前治疗H的想法。pylori在三线治疗中。在本研究中，E-test是用于确定耐药菌株的药敏试验。然而，对甲硝哒唑和克拉霉素的抗生素耐药率相对较高，而对阿莫西林的耐药率极低，这是我们讨论的重点。从广义上讲，E-测试比琼脂稀释法更容易进行，但这些抗生素的当前发现必须用标准方法（如琼脂稀释法）重新评估。标准化是制定有效的H. pylori，Costa et al. [1]需要用金标法确认[2]。此外，甲硝唑的问题更严重，因为已经验证了可靠的方法来确定H。幽门螺杆菌分离株对这种抗生素的敏感性。到目前为止，任何治疗建议，包括甲硝唑应谨慎说明。抗生素耐药性对胃肠病学家来说不再是一个新出现的问题，因为我们正面临着困境，而且没有其他有效的抗生素。经常报告的一线和二线治疗H失败。幽门螺杆菌的感染正在增加，迫切需要注意改进目前的耐药概念和治疗策略[3]。临床医生被迫使用无效的抗生素，虽然没有敏感性的建议。最近指南中的新制剂效果不佳，因此，非常需要临床环境中的新方法[4]。例如，分子检测是促进检测过程的新候选者。此外，粪便样本似乎比活检更好，因为它是一种简单费力的准备和非侵入性方法，更适合患者。最后但并非最不重要的是，使用先进的遗传工具和更好的蛋白质组学数据可以帮助我们设计有毒的H。幽门螺杆菌菌株是有问题的，新的治疗方案应该只针对这些菌株。
We read with interest the article by Costa et al.[1], investigating the efficacy and tolerability of the culture-guided method detecting the Helicobacter pylori (H. pylori) infection. Apart from the very interesting sort of findings reported by the authors, there are some comments improving the current idea in the treatment of H. pylori in the third-line treatment. In this study, E-test was the susceptibility test used to determine resistant strains. However, relatively high rates of antibiotic resistance to metronidazole and clarithromycin and extremely low rate of resistance to amoxicillin are the point of our discussions. Broadly defined, the E-test is less laborious to conduct than the agar dilution method, but the current findings for those antibiotics must be re-evaluated with a standard method such as agar dilution. As standardization is an inevitable part of designing a useful guideline in the therapy of H. pylori, current results by Costa et al.[1] need to be confirmed by gold standard method [2]. Moreover, the problem is worse about metronidazole as the reliable method is validated to determine the susceptibility of H. pylori isolates to this antibiotic. So far, any therapeutic recommendation that includes metronidazole should be cautiously stated. Antibiotic resistance is not an emerging problem for gastroenterologists anymore as we are facing the dilemma and have no other effective antibiotics on the table. Frequently reported failures in the first and second line therapies of H. pylori are increasing and urgent attention to refining current concept of resistance and therapeutic strategies are required [3]. Clinicians are forced to use ineffective antibiotics, although no susceptibility profile is suggested. Newer formulations in recent guidelines are not well-effective, therefore, new approaches in clinical settings are highly needed [4]. For example, molecular detection is a novel candidate to facilitate detection process. Also, feces sample seems better than biopsy as it is an easy laborious preparation and a noninvasive method and preferable for patients. Last but not least, using developed genetic tools with better proteomics data can help us to design virulent H. pylori strains that are problematic and new therapeutic regimens should only target those strains.