The Journal of infectious diseases · 2013
Eradication of Helicobacter pylori according to 23S ribosomal RNA point mutations associated with clarithromycin resistance.
СтатьяРандомизированное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Lee Hyun Jeong, Kim Jin Il, Cheung Dae Young, Kim Tae Ho, Jun Eun Jung, Oh Jung-Hwan, Chung Woo Chul, Kim Byung-Wook, Kim Sung Soo, Park Soo-Heon, Kim Jae Kwang
Аннотация
BACKGROUND: Clarithromycin-resistant Helicobacter pylori is associated with point mutations in the 23S ribosomal RNA (rRNA) gene.
METHODS: A total of 1232 patients participated and were divided into 2 control groups and 1 case group. Patients in the APC control group, which consisted of 308 randomly assigned participants, were treated with standard triple therapy, consisting of amoxicillin, rabeprazole, and clarithromycin; 308 participants in the APM control group were treated with amoxicillin, rabeprazole, and metronidazole. For the 616 participants in the case group, a test for point mutations in the 23S rRNA gene of H. pylori was conducted. A total of 218 individuals in the case group received a new tailored therapy regimen, in which amoxicillin, rabeprazole, and clarithromycin were given in the absence of a mutation, whereas clarithromycin was replaced by metronidazole if the mutation was detected.
RESULTS: The rate of eradication of H. pylori in the tailored group was 91.2% (176/193), which was significantly higher than that in the APC (75.9% [214/282]; P < .001) and APM (79.1% [219/277]; P < .001) control groups.
CONCLUSION: The rate of H. pylori eradication among patients who received tailored therapy on the basis of detection of a clarithromycin resistance mutation by polymerase chain reaction was much higher than the rate among patients who received a standard triple therapy regimen.
CLINICAL TRIALS REGISTRATION: NCT0145303.
METHODS: A total of 1232 patients participated and were divided into 2 control groups and 1 case group. Patients in the APC control group, which consisted of 308 randomly assigned participants, were treated with standard triple therapy, consisting of amoxicillin, rabeprazole, and clarithromycin; 308 participants in the APM control group were treated with amoxicillin, rabeprazole, and metronidazole. For the 616 participants in the case group, a test for point mutations in the 23S rRNA gene of H. pylori was conducted. A total of 218 individuals in the case group received a new tailored therapy regimen, in which amoxicillin, rabeprazole, and clarithromycin were given in the absence of a mutation, whereas clarithromycin was replaced by metronidazole if the mutation was detected.
RESULTS: The rate of eradication of H. pylori in the tailored group was 91.2% (176/193), which was significantly higher than that in the APC (75.9% [214/282]; P < .001) and APM (79.1% [219/277]; P < .001) control groups.
CONCLUSION: The rate of H. pylori eradication among patients who received tailored therapy on the basis of detection of a clarithromycin resistance mutation by polymerase chain reaction was much higher than the rate among patients who received a standard triple therapy regimen.
CLINICAL TRIALS REGISTRATION: NCT0145303.
Предметные рубрики MeSH
2-PyridinylmethylsulfinylbenzimidazolesAdultAgedAmoxicillinAnti-Bacterial AgentsClarithromycinDrug Resistance, BacterialDrug Therapy, CombinationFemaleHelicobacter InfectionsHelicobacter pyloriHumansMaleMetronidazoleMiddle AgedPoint MutationPolymerase Chain ReactionProton Pump InhibitorsRNA, Ribosomal, 23SRabeprazoleTreatment OutcomeYoung Adult