| 抄録 |
Background ： Genotypic resistance for’ clarithromycin and levofloxacin was shown to correlate with sus－ceptibility test and treatment outcomes．Methods ： 91 Patients who failed from at least two treatments for H． pylori infection were enrolled sinceApril2009 in Taiwan． Genotypic resistance for 23S rRNA and gyrA mutations was determined on gastricbiopsy specimens and H． pylon’ strains． Phenotypic resistance was also determined by Agar dilutien testfor correlation． Patients were treated with sequential therapy containing esomeprazole and amoxicillin forthe first 7 daysfollowed by esomeprazole an d metronidazole plus either （1） clarithromycinor （2） levoflox－acinor （3） tetracycline for another 7 days （all given twice daily） according to genotypic resistance． H．pylori status was determined by i3C－UBT at least 6 weeks after completion of treatment．Results ： 75 patients enrolled had results available for analysis up to May 122011． The prevalence of resis－taznce for clarithromycinlevofloxacintetracyclinemetronidazoleand amoxicillin were 77．50／o46．2％O O／o660／oand 8．30／orespectively． The overall eradication rate was 86．7％ （65／7595 O／o CI 79．0 O／o to 94．4 O／o ） in theintention－to－treat （ITT） analysis and was 87．70／o （65／74950／o CI 80．40／o to／95．30／o） in the per protocol （PP）analysis． The eradication rates in patients who received clarithromycin－based （N ＝ 9）levofloxacin－based（N＝29）and tetracyclme－based （N＝37） sequential therapy were 88．90／o （8／9）96．60／o （28／29）and 78．40／o（29／37） in the ITT analysisrespectivelyand were 88．90／o （8／9）96．60／o （28／29）and 80．60／o （29／36） in thePP analysisrespectively．Conclusion ： This pilot study showed that genotypic resistance guided modified sequential therapyachieved good eradication rate （＞850／o） in the third line treatment for H．pylori infection． |
