RESUMO
Background: The increasing in antibiotic resistance of Helicobacter pylori (Hp) has become the main cause leading to the decreasing of the eradication rate for Hp treatment. Aims: To investigate the risk factors of drug resistance of Hp. Methods: Data on 396 patients with Hp infection from Dec. 2016 to Mar. 2021 at Army Medical University were retrospectively analyzed. Drug susceptibility test was used to evaluate the resistance of 6 antibacterial drugs (metronidazole, clarithromycin, levofloxacin, amoxicillin, tetracycline and furazolidone). Unconditional Logistic regression was used to investigate the risk factors affecting Hp antibiotic resistance. Results: In 396 patients with Hp infection, the resistance rates of metronidazole, clarithromycin, levofloxacin, amoxicillin, tetracycline and furazolidone were 96.5%, 45.5%, 41.9%, 0.3%, 0.3% and 0, respectively. Multivariate analysis showed that previous regimen containing clarithromycin was a risk factor for clarithromycin resistance (P 40 years old was a risk factor for levofloxacin resistance (P< 0.001). Conclusions: The resistance rates of metronidazole, clarithromycin and levofloxacin are relatively high, and regimens containing these antibiotics should be avoided without the support from drug susceptibility results, especially in patients who have accepted clarithromycin‑containing regimen or more than 40 years old. Amoxicillin, tetracycline and furazolidone should be recommended preferentially for Hp treatment empirically.
RESUMO
Background: Helicobacter pylori (Hp) infection is related to the occurrence of many upper digestive tract diseases, and the eradication rate has been decreasing year by year. Aims: To investigate the risk factors affecting initial eradication rate of Hp infection. Methods: Clinical data of 428 patients with Hp infection were retrospectively analyzed. Four regimens (14-day esomeprazole 20 mg + amoxicillin 750 mg, qid; 10-day esomeprazole 20 mg + amoxicillin 750 mg, qid; 14-day esomeprazole 20 mg + amoxicillin 1 000 mg, tid; 14-day esomeprazole 20 mg + bismuth 220 mg + amoxicillin 1 000 mg + clarithromycin 500 mg, bid) were given, and effect of antibiotic resistance on Hp eradication was analyzed, the relevant risk factors affecting the eradication rate of Hp were investigated. Results: The eradication rate of ITT analysis was 86.4%, PP analysis was 87.6%. The eradication rates of 4 regimens for ITT analysis were 90.8%, 79.8%, 82.7%, 91.9%, respectively, and were 90.8%, 81.2%, 85.1%, 92.7% for PP analysis, respectively. The antibiotic resistance rate was 30.3%, 97.4% and 36.8% for clarithromycin, metronidazole and levofloxacin, respectively. The recurrence rate of 116 patients was 4.3% after one year of eradication. Smoking, poor compliance, CYP2C19 gene polymorphism were risk factors for eradication rate of Hp (P<0.05). Conclusions: Smoking, poor compliance and ultra-rapid metabolizers, extensive metabolizers of CYP2C19 gene polymorphism can reduce Hp eradication rate. In clinical practice, patient education should be strengthened to urge patients to quit smoking. The quality of follow-up should be improved and proton pump inhibitor that has less impact on CYP2C19 gene polymorphism should be used, thereby increase the Hp eradication rate.