Impact of Helicobacter pylori resistance to clarithromycin on the efficacy of the omeprazole-amoxcillin-clarithromycin therapy
Impact of Helicobacter pylori resistance to clarithromycin on the efficacy of the omeprazole-amoxcillin-clarithromycin therapy
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DOI：
10.1046/j.1365-2036.2001.00971.x
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发表时间：
2001-05-01
影响因子：
7.6
通讯作者：
Delchier, JC
中科院分区：
文献类型：
--
作者：
Tankovic, J;Lamarque, D;Delchier, JC
背景资料：幽门螺杆菌对克拉霉素的耐药性在法国相对频繁，被认为是质子泵转运体-阿莫西林-克拉霉素失败的主要原因（质子泵旁路-AC）疗法，这是法国的一线疗法。目的：确定克拉霉素原发性耐药和继发性耐药对质子泵抑制剂疗效的各自影响-AC方案，并确定失败是否与同一菌株的持续存在或与一个新的出现。幽门感染的患者用奥美拉唑20 mg b.d.治疗7天，阿莫西林1 g b.d.，和克拉霉素500 mg b.d. 102例患者通过呼气试验评估根除情况。采用E-test法测定克拉霉素的最小抑菌浓度。采用随机扩增多态性DNA（RAPD）技术对菌株进行基因分型。治疗前后克拉霉素耐药率为19%（123人中的23人）和69%根除率为68%所有菌株、敏感菌株和耐药菌株的分离率分别为79%（67/102）、79%（67/85）和12%（2/17）。治疗后分离株可用于6例具有敏感治疗前分离株和持续感染的患者。耐药性出现在两个病人，并与持久性的预处理菌株在一个和一个新的菌株的选择，在其他Conclusions：在我们的医院，质子泵支架-AC治疗的失败都与克拉霉素原发性和继发性耐药性，但继发性耐药性的出现并不能解释所有的失败，在初始克拉霉素敏感组。在这个群体中，失败后可能会出现新的菌株。
Background: Helicobacter pylori resistance to clarithromycin is relatively frequent in France and is assumed to be the main cause of failure of the proton pump inhibitor-amoxicillin-clarithromycin (proton pump inhibitor-AC) therapy, which is the first-line regimen in France.Aim: To determine the respective effects of clarithromycin primary and secondary resistances on efficacy of the proton pump inhibitor-AC regimen and to determine whether failures are associated with persistence of the same strain or with emergence of a new one.Methods: A total of 123 H. pylori-infected patients were treated for 7 days with omeprazole 20 mg b.d., amoxicillin 1 g b.d., and clarithromycin 500 mg b.d. Eradication was assessed by breath test in 102 patients. Minimal inhibitory concentrations of clarithromycin were determined by E-test. Strain genotyping was performed by random amplified polymorphic DNA.Results: The pre-treatment and post-treatment prevalences of clarithromycin resistance were 19% (23 out of 123) and 69% (nine out of 13), respectively, The rates of eradication were 68% (69 out of 102), 79% (67 out of 85), and 12% (two out of 17) for all, susceptible and resistant strains, respectively. The post-treatment isolate was available for six patients with a susceptible pretreatment isolate and a persistent infection. Resistance emerged in two patients and was associated with persistence of the pre-treatment strain in one and with selection of a new strain in the other.Conclusions: In our hospital, failures of the proton pump inhibitor-AC therapy are related to both clarithromycin primary and secondary resistances, but the emergence of secondary resistance does not explain all of the failures in the initial clarithromycin-susceptible group. In that group a new strain can emerge after failure.