RESISTANCE TO ANTIMICROBIALAGENTS IN ERADICATION OF HELICOBACTER PYLORI INFECTION
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With the recent increasingly widespread use of triple therapy to eradicate Helicobacter pylori (H. pylori) consisting of a proton pump inhibitor (PPI), amoxicillin (AMPC), and clarithromycin (CAM) [PPI/AC], the issue of resistance to antimicrobial agents has risen. In this study, we investigated the rate of increase in antimicrobial resistance after eradication treatment and the mechanism of the increase in CAM resistance.Subjects and Methods: The subjects were 277 patients with digestive diseases, all of whom were positive for H. pylori. Eradication therapy with PPI/AC was administered. Before and after the treatment, endoscopy was performed, and the gastric mucosal specimens were obtained from 2 sites, antrum and body. The presence or absence of H. pylori infection was evaluated by culture/histological examination. In all patients with positive reactions on culture, the susceptibility to AMPC, CAM, and metronidazole (MNZ) was measured by the agar plate dilution method.Results: The rate of eradication was 83.7% (216/258, per protocol). Prior to the treatment, the rates of bacteria resistant strains to AMPC, CAM, or MNZ were 1.1%, 6.9%, and 2.6%, respectively. The susceptibility to AMPC/CAM in both the antrum and body regions could be measured in 212 and 208 patients, respectively. Prior to the treatment, 1.4% (3/212) and 8.6% (18/208) of the patients were resistant to AMPC and CAM, respectively. After the treatment, the percentages were increased to 5.4% (2/37) and 64.9% (24/37), respectively. In addition, concerning CAM, in 5 patients, CAM-sensitive bacteria were detected in one of the two regions, the antrum and body, while CAM-resistant bacteria were detected in the other region (mixture of resistant and sensitive bacteria). In these patients, eradication was all unsuccessful. After the treatment, CAM-resistant bacteria were detected in both the antrum and body.Conclusions: The rate of eradication with PPI/AC therapy was 80% or more; however, the rate of CAM-resistant bacteria was increased after the treatment. These results suggest that the acquisition of CAM resistance by H. pylori and bacterial selection of H. pylori are involved in the increase after eradication treatment.
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日本癌病態治療研究会 | 論文
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