Study On The Resistance Of Helicobacter Pylori To Common Antibiotics In Fujian And The Efficacy Of Current Eradication Regimens

Objective To determine the resistance patterns of Helicobacter pylori strains isolated from patients in Fujian province to common antibiotics(metronidazole,clarithromycin,amoxilin,levofloxacin,tetracycline,furazolidone)and compare the eradication rate of several treatment regimens.Part I: Study on antibiotics resistance of Helicobacter pyloriMethods1.Gastric mucosal biopsy specimens were collected from patients with endoscopy due to upper gastrointestinal symptoms.2.Hp was isolated and cultured in a microaerobic atmosphere.Morphological identification(such as colony morphological identification and Gram stain)and biochemical identification(eg,urease test,catalase test)were uesd to identify the isolated strains.3.The resistance of Helicobacter pylori to metronidazole,clarithromycin,amoxicillin,levofloxacin,tetracycline and furazolidone were detected by agar dilution.4.Compare the resistence rates of H.pylori to six antibiotics above from patients with different age,sex and region.Results1.Antibiotic resistance: the resistance rates of isolates obtained were 94.91%,37.96%and 25.46% to metronidazole,levofloxacin and clarithromycin respectively.he resistance rates of amoxicillin,tetracycline and furazolidone were all 0.00%.2.The rates of single resistance,double and multiple resistances of clinical isolated strains: single resistance,double resistance,multiple resistance and full sensitive were44.91%,39.35%,11.57% and 4.17% respectively.3.The rates of antibiotics resistance in various ages: the metronidazole resistance rate for patients younger than 40 years was greater than that of patients over 40 years of age,the difference was significant between the two groups(P <0.05).There was no significant difference in the other antibiotics between different age groups(P> 0.05).The rate of single drug resistance,double resistance,multiple drug resistance and full sensitivity had no significant difference between different ages(P> 0.05).4.The rates of antibiotics resistance in different sex: there was no significant difference between different sex in antibiotics resistance(P> 0.05),and there was no significant difference in single drug resistance,double resistance,multiple drug resistance and full sensitivity between different gender(P> 0.05).5.The rates of antibiotics resistance in different areas: the resistant rate of Hp to metronidazole was 98.20% and 91.43% in Nanping and Fuzhou area respectively,and the difference was significant(p <0.05).Other antibiotics resistance rates had no significant difference between different regions(P> 0.05).Part II: Evaluation of part of Helicobacter pylori eradication regimensMethods Compared the efficacy of three different regimens in the case of empirical treatment.The regimens were as follows : A group of standard triple regimen(esomeprazole 20 mg bid + clarithromycin 500 mg bid + ornidazole 500 mg bid,14d),Group B of standard triple improvement regimen(esomeprazole 20 mg bid +clarithromycin 500 mg bid + ornidazole 500 mg bid + acetyl-cysteine 600 mg bid,14d)and group C with levofloxacin regimen(esomeprazole 20 mg bid + levofloxacin500 mg qd + ornidazole 500 mg bid + Jing Hua Wei Kang capsule 160 mg bid,14d).The occurrence of adverse reactions during the treatment was recorded.At least4 weeks after discontinuation,13 C urea breath test was used to test the eradication effect.Compared the eradication rate of different treatment regimens and the occurrence of adverse reactions.Results1.General information: there was no significant difference in gender,ages and disease distribution among the three groups(P> 0.05).The data was comparable.2.Eradication rates:the eradication rate of group B(standard triple program improvement program)was 86.8%,which was the highest,while the eradication rate of group A(standard triple regimen)and group C(levofloxacin-containing regimen)was 65.8% and 83.9% respectively.The difference of eradication rate among the three groups was not significant(P> 0.05).3.Adverse reactions:the major adverse reactions among three groups were nausea,mouth pain,bloating and insomnia,with no related drug treatment and diasppeared after drug withdrawal.There was no significant difference in adverse events among the groups(P> 0.05).Conclusions In Fujian area,Hp is highly resistant to metronidazole,levofloxacin and clarithromycin.There are double and multiple drug resistance to these three antibiotics and no amoxicillin,tetracycline,furazolidone resistance.Standard triple regimen eradication rate is low,standard triple improvement regimen and levofloxacin treatment regimen can improve the eradication rate,but both regimens need to further expand the sample to observe its efficacy.It is recommended to continue to monitor the antibiotic resistance and eradication therapy in Fujian,choose antibiotics and regimens reasonably and timely adjust treatment regimens in order to improve the eradication rate of Hp in Fujian province.