頁籤選單縮合
題 名 | Impact of Helicobacter Pylori Antimicrobial Resistance on the Outcome of 1-Week Lansoprazole-Based Triple Therapy=幽門桿菌抗藥性菌株對合併使用Lansoprazole三合一療法之影響 |
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作 者 | 黃愛惠; 許博翔; 楊曉白; 黃靖淳; 吳俊忠; 林錫璋; | 書刊名 | 臺灣醫學會雜誌 |
卷 期 | 99:9 2000.09[民89.09] |
頁 次 | 頁704-709 |
分類號 | 414.83 |
關鍵詞 | 幽門桿菌抗藥性菌株; Lansoprazole三合一療法; Lansoprazole; Clarithromycin; Amoxicillin; Metronidazole; Helicobacter pylori; |
語 文 | 英文(English) |
英文摘要 | Purpose: To determine the effect of Helicobacter pylori antimicrobial resistance on the efficacy of different proton pump inhibitor (PPI)-based triple theraples. Methods: One-hundred and twelve dyspeptic patients with H. pylori infection, as demonstrated by positive histology and culture, were randomized to receive one of the three PPI-based triple therapies. The regimens included lansoprazole (L) plus any two of the following three antibiotics: amoxicillin (A), metronidazole (M), and clarithromycin (C); patients were allocated to ALC, MLC, and ALM subgroups. Six weeks after the start to triple therapy, the 13C-urea breath test (UBT) was performed to evaluate the success of H. pylori eradication. Patients with positive UBT results underwent endoscopy for H. pylori culture. The pre- and post-treatment H. pylori isolates were analyzed for initial and acquired resistance using the E-test. Results: One hundred patients completed the study. The H. pylori eradication rates were 70% (21/30) in the ALM subgroup, 79% (26/33) in the MLC, and 89% (33/37) in the ALC subgroup. The frequencies of pretreatment H. pylori antimicrobial resistance were 0% for amoxicillin resistance (AR), 32% for metronidazole resistance (MR), and 6% for clarithromycin resistance (CR). For H. pylori isolates with initial MR, the eradication rates in the ALM (40%) and MLC (67%)subgroups were apparently lower than that in the ALC (92%) subgroups. In the ALM and MLC subgroups (ie, patients who received metronidazole), the eradication failure rate was significantly higher for patients with MR isolates than for patents with metronidazole-susceptible isolates (47% vs 16%, p<0.05). In the ALC and MLC subgroups (ie, patients who received clarithromycin), the eradication failure rate was significantly higher for patients with CR isolates that for those with clarithromycin-susceptible isolates (100% vs 11%, p<0.05). Conclusions: The results indicate that H. pylori autimicrobial resistance is relevant to the success of eradication. The high MR but low CR and AR prevalence among H. pylori isolates in this study suggests that PPI-based triple therapy including amoxicillin and clarithromycin may achieve the most favorable eradication rate. |
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