Current situation of Helicobacter pylori resistance in China

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China is a country with high incidence of Helicobacter pylori (Hp) infection, so clinicians pay special attention to the treatment of Hp inf


China is a country with high incidence of Helicobacter pylori (Hp) infection, so clinicians pay special attention to the treatment of Hp infection. Beijing branch of the Chinese Medical Association from June 27, 2008 to July 1st in Shenzhen city held the third national Helicobacter pylori infection and gastrointestinal mucosal barrier injury in clinical diagnosis and treatment of the forum, to further improve China's medical workers of water in diagnosis and treatment of Hp infection and gastrointestinal mucosal barrier injury level. At the meeting, a number of experts to carry out academic reports, participants actively participate in the discussion. We invited several experts according to the content of the conference, published in the D3~D6 version, to share with our readers.

It has been 26 years since the discovery and isolation of Helicobacter pylori (Hp). 26 years of research, the rapid development of Hp, people of Bacteriology, Hp epidemiology, pathogenic mechanism, whether from basic to clinical, or from the cell level to the molecular mechanism of research and exploration have been made systematically and deeply.

Hp infection accounted for more than half of the world's population, China is a high rate of Hp infection state, so the clinical treatment of Hp infection is the key problem of Hp field in our country, but also our clinicians to Hp research the most concern.

What is the clinical problem in the treatment of Hp infection? Mainly including the following aspects: who should treat? Namely Hp eradication therapy indications; second is how to treat? Hp eradication therapy; and how to avoid or overcome resistance to Hp?

On the above discussions, China has successively published 3 times on the Hp infection process of consensus, in 1999 the "Hainan consensus", in 2003 the "Tongcheng consensus" and the "Mount Lu" on 2007. The difficulty in the eradication of Hp is the occurrence of antibiotic resistance to Hp, and the drug resistance of Hp is the main reason leading to the eradication of Hp.

Not optimistic: current status of Hp resistance in China

Chinese scholars have done in-depth research on the treatment of Hp infection, Hp eradication has many treatment options, including proton pump inhibitor (PPI) plus two antibiotics triple therapy is still the current domestic and foreign Hp consensus recommended first-line therapy, the most commonly used clinical antibiotics including metronidazole, clarithromycin and amoxicillin. With the wide application of antibiotics, the resistance rate of Hp to these antibiotics is also increasing year by year. The main reason for the failure of PPI triple therapy is that Hp is resistant to antibiotics. Among them, Hp resistance to metronidazole is global, the developing countries than in developed home run.

In order to know the situation of antibiotic resistance of Hp Chinese, Digestive Disease Branch of Hp group in the period from March 2005 to December 2006 completed a study involving 16 provinces and cities nationwide including more than and 20 large-scale Hp resistance center of Chinese Medical Association (including metronidazole, clarithromycin and amoxicillin A Mo) epidemiological investigation, research and develop the impact resistance of smelting treatment, the research results are as follows.

Regional differences in drug resistance

Our Hp resistance to different antibiotics were: metronidazole 50%~100% (average 75.6%), 0~40% (average 27.6%), clarithromycin, amoxicillin 0~2.7%. The resistance of Hp to antibiotics was very different in different regions, especially the resistance to metronidazole. In Shanghai and Hubei, the resistance rate of Hp to metronidazole was as high as 100% in the Shandong area, which was about 50%, which indicated that there was significant regional difference in Hp resistance.

Drug resistance rate increased year by year

In the Beijing area, Hp resistance to metronidazole rate increased from 36% in 1999 to 76% in 2004, to 2007, the resistant rate was 81%; the rate of Hp resistance to clarithromycin increased from 10% in 1999 to 36% in 2005, to 2007, the resistant rate was 38.1%. Fortunately, Hp was very resistant to amoxicillin, and the resistance rate was 2.7%.

In the area of Nanchang, from 2004 to 2006 for a period of 3 years, resistance to metronidazole, amoxicillin, clarithromycin, tetracycline and the rate gradually increased. From 50% 2004, metronidazole (102 /204) to 53.1% (51 /96 cases), amoxicillin (9 /204) from 4.4% to 10.4% (10 /96), clarithromycin (18 /204) from 8.8% to 9.4% (9 /96 cases), tetracycline (9 cases from 4.4% /204 to 5.2% /96 (5 cases)).

Hp resistance to tetracycline and levofloxacin

Tetracycline is a commonly used drug in the treatment of Hp resistance to other antibiotics. Recently, we have studied the occurrence of tetracycline resistance in the Hp strain of Beijing. We tested tetracycline resistance in 31 Hp positive patients who had not been treated with tetracycline. The results showed that 31 strains of Hp isolated from the clinical isolates were found to be resistant to tetracycline only in the 1 strains. The minimum inhibitory concentration (MIC) of resistant strains was 8 g/ml, and the other strains were MIC in the range of g/ml (g/ml~0.38), which were all sensitive to tetracycline.

The results showed that the resistance rate of Hp to tetracycline was 3.2%, which indicated that the isolated Hp strains in Beijing were sensitive to tetracycline. At the same time, in the Nanchang area of Hp resistant to tetracycline was 5.5% (5/96 cases), Xi'an 1.7% (1/60 cases), therefore, Hp resistance to tetracycline and tetracycline was low, low price, is the ideal drug Hp remedial treatment, unfortunately, almost in the country do not buy tetracycline to.

Levofloxacin is in the last two years at home and abroad Hp consensus opinion was newly recommended Hp eradication drugs, is gradually used in clinical. However, a recent study showed that the resistance rate of Hp to levofloxacin was 29.1% in Beijing, Shanghai in and in Xi'an (13/60).

The effect of Hp resistance on eradication of Hp

Hp resistance to metronidazole is an important cause of Hp eradication failure. Chinese Medical Association, a national multi center clinical study of the Hp study group were showed in 910 cases of Hp positive patients, LCA group without metronidazole (levofloxacin + clarithromycin + amoxicillin) the eradication rate of Hp was significantly higher than that of LCM group containing metronidazole (levofloxacin + clarithromycin + metronidazole (P). 0.05).

The study also suggested that resistance to clarithromycin the Hp eradication rate is lower, if the patients of metronidazole and clarithromycin resistance at the same time, the Hp eradication rate is lower, even for 0.

Positive response: how to avoid Hp resistance

How to avoid the emergence of resistant strains is one of the key points in the future research. To avoid the generation of Hp resistant strains, my experience is as follows:

- according to the treatment plan, regular and effective treatment of Hp eradication treatment, strict control of indications. Gastroenterologists should work closely with physicians, and strengthen the popularization and renewal of grassroots doctors for treatment of Hp knowledge, especially to understand and learn to launch in August 2007 10-12 in Mount Lu in Jiangxi held the third session of the national Hp consensus conference on "on the treatment of Hp infection in consensus", which can effectively guide the doctor standardized treatment in clinical work, according to the specific circumstances of the patient.

The combined use of drugs, to avoid the single antibiotic eradication of Hp, used alone any kind of antibiotics are prone to drug resistance. The combination of antibiotics and bismuth or PPI can not only reduce the production of Hp resistant strains, but also improve the eradication rate of Hp.

The first treatment, clinicians formulate an effective treatment plan is especially important. In order to improve the eradication rate of Hp, quadruple therapy can also be used for the first treatment, can reduce relapse, so as to avoid the repeated treatment caused Hp of secondary resistance to antibiotics.

In areas where conditions were detected with Hp when the resistance rate of metronidazole resistance rate was higher than 40%, clarithromycin is greater than or equal to 15%~20%, it is not appropriate to use metronidazole or clarithromycin.

To accept continuous treatment but many failed patients, after the recommended interval of 3~6 months to recover the activity of Hp, and then received Hp eradication therapy, in order to improve the eradication rate of Hp.

There are still many clinical problems in the treatment of Hp infection. About the diagnosis and treatment of Hp infection can refer to this year just published the "guide to the diagnosis and treatment of Helicobacter pylori," a book.

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