The drug resistance situation of Helicobacter pylori infection in Meizhou and the treatment countermeasures

Abstract

Objective To understand the Helicobacter pylori （ Hp） infection eradication rate of standard tri-ple therapy in Guangdong Meizhou and the drug resistance situation for metronidazole ,clarithromycin ,amoxicillin and levofloxacin ,in order to look for the treatment countermeasures in Hp eradication failure .Methods 297 cases of Hp positive patients because of gastrointestinal symptoms to our hospital examined from April 2011 and March 2013,were randomly assigned into three standard triple therapy groups：A （ OCA ） group and B （ OCM ） group and C （ OCL ） group.The Hp eradication rate was analyzed .Patients with primary treatment failure were selected as group D （OBAL）,proceed to （PPl＋B＋A＋L）7 d therapy,the Hp eradication rate was analyzed .230 Hp strains were isola-ted and cultured from 297 cases received the first eradication therapy and 87 cases received again eradication therapy . The minimum inhibitory concentration （MIC） of metronidazole,clarithromycin,amoxicillin and levofloxacin were tested by E-test,in order to determine the resistance of these four antibiotics in clinical isolated Hp strains .Results With intention-to-treat（ITT） analysis,the Hp eradication rates of group A （OCA）,group B（OCM） and group C（OCL） were 72.0%（72/100）,63.0%（63/100） and 72.2%（70/97）,respectively.With per-protocol（PP） analysis,the Hp eradication rates of group A （OCA）,group B（OCM） and group C（OCL） were 72.7%（72/99）,64.3%（63/98）,73.7%（70/95）,respectively.The eradication rate among three standard triple therapy groups had no obvi-ous difference （ITT：P=0.278,PP：P=0.288,P〉0.05）.With ITT analysis,the Hp eradication rate in the quadrup-le therapy group D（OBAL） was 92.0%（80/87）.With per-protocol（PP） analysis,the Hp eradication rate in the quadruple therapy group D（OBAL） was 97.6%（80/82）,which was higher than that of the three standard triple ther-apy groups（ITT：P=0.000,PP：P=0.000）.In 230 clinical isolated Hp strains,the resistant rates of levofloxacin,amoxicillin,clarithromycin and metronidazole were 6.08%（14/230）,6.52%（15/230）,25.65%（59/230）, 70.87%（163/230）,respectively.Of those 37 strains were mixed resistance,the mixed resistant rate was 16.09%（37/230）.The resistant rate of metronidazole was higher than levofloxacin , amoxicillin and clarithromycin （ P =0.000,P〈0.01）,the resistant rate of clarithromycin was higher than levofloxacin and amoxicillin （P=0.000）,no statistically significant difference between amoxicillin and levofloxacin （P=0.848）.Conclusion The Hp resistance is similar to the national average in Guangdong Meizhou ,the eradication rate of standard triple therapy is lower than 80%,contain bismuth agent of quadruple therapy is good rescue therapy . Key words: Helicobacter pylori; Drug sensitive test; Drug resistance,bacterial; Rescue therapy