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Panel Discussion 8
Medical Science Communication at the GlobalAge Part2:The Future of Gastroenterology in Asia
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| タイトル |
PD8-2-4 Treatment of Helicobacter pylori Infection-Application of Genotypic Resistance into Clinical Practice
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| 共同演者 |
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| 抄録 |
The eradication rate of standard therapy for Hl pylori ’tnfection has been decreasing due to in－creased prevalence of antibietic resistaiice． Antibiotic resistance can be detected by either theculture－based techniques （phenotypic resistance） or the nucleic acid－based techniques （gen｝typic resistarrce）． Mutations in the 23S rRNAgyrA16S rRNARcixAand PBP1 genes Qf E py－lon’ are associated with macrolidesfluoroquinQlonetetracyclinesnitroimidazolesand amoxicil一躍resistancerespectively． Mutation in 23S rRNA was shown to be assodated with a lowe「eradication rate in patients treated with clarithromycin－based triple therapyHowevGrwhether gyrA mutation was associated vvith treatrneBt outcomes aber levofioxacin J－basedtherapies has not heen reported We showed that the eradeation rate of levofioxacin－based tri－pie therapy was slgnificatttly abected by the presence of gyrA mutation （41．7％ （5／ma） vs827％（11e／133）p ＝O；003） in the first line therapy． Heweverthe eradieation rate of modified sequen－tial ttterapy containing levofioxacin was less diected by the pre＄ence of gyrA mutation （M％（11／工3）vs、％、4％（副56）P＝0、158）㎞th晩cond㎞e眈rap∬he era唖ca廿on r鑛of記qロen・tial therapy given for 14 days or 10 days were also afected by the presence of 23S rRNA muta－tions lin a pilot clinieai trialpatients who failed from at least two treatments were re－treatedwith sequential therapy coutaining esomeprazole and amexicillin for the first 7 days followed byesameprazole and metronidazole plus eitherr （1） clarithromycia or （2） levofioxacinor （3） tet－racycline for another 7 days （al given tvvice daily） according to gfmotypic resistance The over－ab eradieation rate was 818％（90／110）舳e血tention亡。冒eat姻y曲． Tbe eradication ratewas higher in patients treated with levofloxacin－based than tetracycline－based sequenul ther－apy （95．190 （ee／41） vs．722％ （39／M）p＝Ooo6）． in conclusiongenotypic resistance can be ttseto predict treatment responses and in the guidance of treatment for H pyiori infection． |
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