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Helicobacter:青霉素过敏的幽门螺杆菌感染患者的药敏指导治疗

2021-07-23 MedSci原创 MedSci原创

青霉素过敏的患者幽门螺杆菌(H pylori)的治疗仍十分困难。近日,研究人员评估了对幽门螺杆菌感染的青霉素过敏患者进行药敏指导的一线和救援治疗的有效性和耐受性,研究结果已发表于Helicobacte

青霉素过敏的患者幽门螺杆菌(H pylori)的治疗仍十分困难。近日,研究人员评估了对幽门螺杆菌感染的青霉素过敏患者进行药敏指导的一线和救援治疗的有效性和耐受性,研究结果已发表于Helicobacter。

对青霉素过敏的连续幽门螺杆菌感染患者根据对克拉霉素、左氧氟沙星和甲硝唑的敏感性,接受为期14天的三联或四联疗法。所有患者均接受埃索美拉唑20毫克,每天两次。对甲硝唑敏感的感染者接受甲硝唑加克拉霉素或左氧氟沙星三联疗法,如果对甲硝唑敏感。对克拉霉素和左氧氟沙星耐药的感染者接受甲硝唑加四环素三联疗法。甲硝唑耐药感染接受高剂量甲硝唑铋剂加克拉霉素或左氧氟沙星四联疗法。三重耐药的感染接受经典的铋剂四联疗法和大剂量甲硝唑。采用E试验法评估抗菌药物敏感度。

 

结果,入选的112名患者(34.8%为男性,平均47.1岁)。83.8%(31/37)的治疗无效者和12.0%(9/75)(P<0.001)接受救援治疗者的感染对三种测试的抗生素中至少一种敏感。总的来说,通过意向治疗分析,药敏指导治疗达到了92.9%的根除率(104/112,95%CI为88.1%-97.7%),通过每方案分析达到了99%(100/101,95%CI为97.1%-100%)。在PP人群中,所有方案的根除率都超过了90%(P=0.327)。不良事件相对频繁;然而,依从性仍然很高。

综上,事实证明,易感性指导下的治疗对青霉素过敏的患者非常有效。在有条件且证明局部有效的情况下,替代方案是经典铋剂四联疗法。

 

原始出处:

 

Laisheng Luo, et al., Susceptibility-guided therapy for Helicobacter pylori-infected penicillin-allergic patients: A prospective clinical trial of first-line and rescue therapies. Helicobacter. 2020 Aug;25(4):e12699. doi: 10.1111/hel.12699.  

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    2022-04-20 kcb069
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    2021-07-25 sunyl09

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