Biofilm Demolition and Antibiotic Treatment to Eradicate Resistant Helicobacter pylori: A Clinical Trial
Biofilm Demolition and Antibiotic Treatment to Eradicate Resistant Helicobacter pylori: A Clinical Trial
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DOI：
10.1016/j.cgh.2010.05.006
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发表时间：
2010-09-01
影响因子：
12.6
通讯作者：
Gasbarrini, Giovanni
中科院分区：
文献类型：
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作者：
Cammarota, Giovanni;Branca, Giovanna;Gasbarrini, Giovanni
背景与目的：幽门螺杆菌附着于胃粘膜并形成生物膜。这构成了对抗微生物剂的保护。我们评估了N-乙酰半胱氨酸预处理在破坏生物膜和克服幽门螺杆菌抗生素耐药性方面的作用。方法：在一项开放标签、随机对照试验中，评价了40例至少有4次幽门螺杆菌根除失败史的受试者的生物膜存在、抗生素敏感性和幽门螺杆菌基因型。受试者被随机分配到接受（A组）或不接受（B组）n-乙酰半胱氨酸前培养指导的抗生素方案。主要终点是通过C-13标记的尿素呼气试验评估的幽门螺杆菌根除率。研究结果：A组20名参与者中有13名（符合方案和意向治疗分析，65%; 95%置信区间，44%-86%）根除了幽门螺杆菌，B组20名参与者中有4名（符合方案和意向治疗分析，20%; 95%置信区间，3%-37%）根除了幽门螺杆菌（P <0.01）。生物膜仅在治疗失败的参与者中持续存在。幽门螺杆菌基因型不影响治疗结果。结论：在培养指导的抗生素治疗方案之前进行N-乙酰半胱氨酸预处理可以有效克服幽门螺杆菌抗生素耐药性。
BACKGROUND & AIMS: Helicobacter pylori attaches to gastric mucosa and grows as a biofilm. This constitutes protection from antimicrobial agents. We assessed the role of a pretreatment with n-acetylcysteine in destroying biofilm and overcoming H pylori antibiotic resistance. METHODS: In an open-label, randomized controlled trial, 40 subjects with a history of at least 4 H pylori eradication failures were evaluated for biofilm presence, antibiotic susceptibility, and H pylori genotypes. Subjects were assigned randomly to receive (group A) or not (group B) n-acetylcysteine before a culture-guided antibiotic regimen. The primary end point was the H pylori eradication rate as assessed by C-13-labeled urea breath testing. RESULTS: H pylori was eradicated in 13 of 20 (both per-protocol and intention-to-treat analyses, 65%; 95% confidence interval, 44%-86%) group A participants and 4 of 20 (both per-protocol and intention-to-treat analyses, 20%; 95% confidence interval, 3%-37%) group B participants (P < .01). Biofilms persisted only in unsuccessfully treated participants. H pylori genotypes did not influence treatment outcome. CONCLUSIONS: N-acetylcysteine pretreatment before a culture-guided antibiotic regimen is effective in overcoming H pylori antibiotic resistance.