AJG:先前暴露于大环内酯类抗生素对幽门螺杆菌感染治疗结果的影响

2019-06-19 不详 MedSci原创

最新的治疗幽门螺杆菌(H. pylori)的指南,包括最近的ACG临床指南都建议在接受大环内酯类暴露的患者中避免使用含有克拉霉素的三联疗法(TT-C)。但是支持这一建议的数据很少,大环内酯暴露对四联疗法的影响尚不清楚。因此,本项研究旨在确定大环内酯类暴露对幽门螺杆菌治疗效果的影响。

背景及目标:
最新的治疗幽门螺杆菌(H. pylori)的指南,包括最近的ACG临床指南都建议在接受大环内酯类暴露的患者中避免使用含有克拉霉素的三联疗法(TT-C)。但是支持这一建议的数据很少,大环内酯暴露对四联疗法的影响尚不清楚。因此,本项研究旨在确定大环内酯类暴露对幽门螺杆菌治疗效果的影响。

方法:
研究人员回顾性收集了2010年至2015 年期间接受了13 C-尿素呼气测试阳性的25-60岁年龄段患者。排除了之前接受幽门螺杆菌粪便抗原检测或镜检查的阳性的患者。然后对所有患者进行相关性分析。

结果:
本项研究共确定了7842名受试者(36.1%男性,年龄:40.3 ± 10.5岁),其中3062名(39.0%)患者之前使用过大环内酯类药物。在具有和不具有大环内酯暴露的受试者中,TT-C的功效分别为74.3%和82.4%(优势比(OR),0.62; 95%置信区间(CI),0.55-0.70; P <0.0001)。暴露于克拉霉素(55.5%; OR,0.31; 95%CI,0.24-0.39; P <0.0001),罗红霉素(74.4%; OR,0.65; 95%CI,0.58-0.74; P <0.0001 )对TT成功产生不利影响和红霉素(73.9%; OR,0.72; 95%CI,0.57-0.89; P.<0.01)但不是暴露于阿奇霉素。由于暴露于克拉霉素和罗红霉素与更高的根除相关(OR,1.007; 95%CI,1.002-1.012; P <0.01和OR,1.004; 95%CI,1.002-1.006; P <0.0001)。较高剂量的克拉霉素和红霉素与较低的成功根除相关(OR,0.99988; 95%CI,0.99982-0.99996; P <0.01和OR,0.99981; 95%CI,0.99971-0.99992; P <0.001)。

结论:  
TT-C疗法会受到先前接触大环内酯类抗生素的不利影响。

原始出处:

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    2020-03-08 minzju5052
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    2019-07-19 kcb069
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