Resistance of Helicobacter pylori to antibiotics: the main limitation of current proton-pump inhibitor triple therapy.
Resistance of Helicobacter pylori to antibiotics: the main limitation of current proton-pump inhibitor triple therapy.
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幽门螺杆菌对抗生素的耐药性：当前质子泵抑制剂三联疗法的主要局限性。
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发表时间：
1999
期刊：
影响因子：
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通讯作者：
F. Mégraud
中科院分区：
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作者：
F. Mégraud
数据显示幽门螺杆菌耐药的临床相关性，以及最近的数据收集的研究，从2012年，提出。尽管与甲硝唑耐药性检测相关的问题，在大多数质子泵抑制剂三联疗法的研究中发现耐药性与根除失败之间的相关性，其中阿莫西林或克拉霉素与甲硝唑一起用作第二抗生素。克拉霉素耐药性在大多数社区仍然很低。目前的数据很少，但表明当它存在时，它对治疗结果的负面影响比甲硝唑耐药更大。抗药性经常随着治疗失败而出现，尽管不清楚抗药性微生物会传播到什么程度。在1992年的研究中，培养被用作诊断试验之一，与尿素呼气试验相比，其灵敏度为99%。此外，药敏试验几乎可以对所有菌株进行。对克拉霉素和甲硝唑的总体耐药率分别为3%（范围1-5%）和24%（范围16-41%）。奥美拉唑-甲硝唑-克拉霉素治疗甲硝唑耐药菌株的成功率下降了15%（从91%降至76%）。奥美拉唑的加入改善了甲硝唑-克拉霉素双重治疗的疗效。预防耐药性的最佳方法是获得尽可能高的根除率。
Data showing the clinical relevance of Helicobacter pylori resistance, as well as recent data gathered from the MACH2 study, are presented. Despite the problems associated with testing for metronidazole resistance, a correlation between resistance and eradication failure is found in most studies of proton-pump inhibitor triple therapy, in which either amoxycillin or clarithromycin is used as the second antibiotic with metronidazole. Clarithromycin resistance is still low in most communities. Current data are scarce, but indicate that when present it has a higher negative impact on treatment outcome than metronidazole resistance. Resistance frequently emerges with treatment failure, although it is not clear to what extent resistant organisms will spread. In the MACH2 study, culture was used as one of the diagnostic tests and its sensitivity compared with the urea breath test was 99%. In addition, susceptibility tests could be performed on almost all strains. The overall rates of resistance to clarithromycin and metronidazole were found to be 3% (range 1-5%) and 24% (range 16-41%), respectively. There was a 15% decrease in success rate with omeprazole-metronidazole-clarithromycin treatment (from 91 to 76%) for metronidazole-resistant strains. The addition of omeprazole improved the efficacy of metronidazole-clarithromycin dual therapy. The best way to prevent resistance is to obtain the highest possible eradication rate.