Effect of Macrolide Exposure on Tailored Helicobacter pylori Eradication Therapy and Antibiotic Resistance Profiles: A Prospective Study Using the Drug Utilization Review System

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter Pub Date : 2024-12-04 DOI:10.1111/hel.70003

Jin Hee Noh, Kee Don Choi, Hee Kyong Na, Ji Yong Ahn, Jeong Hoon Lee, Kee Wook Jung, Do Hoon Kim, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung

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引用次数: 0

Abstract

Background/Aims

Determining antibiotic use history accurately is challenging due to its reliance on patient recall. By determining macrolide exposure using the Korean drug utilization review (DUR) system, we analyzed the impact of previous macrolide use on antibiotic resistance profiles and compared the eradication rate between tailored therapy based on macrolide exposure history and empirical therapy.

Methods

Patients with confirmed Helicobacter pylori (H. pylori) infection who agreed to access prescription information using the Health Insurance Review and Assessment Service DUR system were enrolled between 2021 and 2023. Patients received tailored therapy, which was clarithromycin (CLR)-based triple therapy in cases without macrolide exposure and bismuth quadruple (BQ) therapy in cases with macrolide exposure. The empirical therapy group was prospectively recruited at the same time to compare the eradication rate.

Results

A total of 418 patients (tailored therapy group, n = 57; empirical therapy group, n = 361) were analyzed. Among the tailored therapy group, 24.6% took macrolide antibiotics for the past 5 years. CLR resistance rates were higher in patients with previous macrolide use than in those without (66.7% vs. 7.5%, p < 0.001). The tailored therapy group showed a higher eradication rate than the empirical therapy group for intention-to-treat (ITT), modified intention-to-treat (MITT), and per-protocol (PP) analyses (ITT, 86.0% vs. 75.6%; MITT, 94.2% vs. 80.3%; PP, 94.2% vs. 85.1%).

Conclusions

Previous macrolide exposure identified using the DUR system was associated with a higher rate of CLR resistance. Tailored therapy based on macrolide exposure history led to higher eradication rates compared to empirical therapy.

查看原文本刊更多论文

大环内酯暴露对幽门螺杆菌根除治疗和抗生素耐药性的影响：一项使用药物利用审查系统的前瞻性研究

背景/目的由于依赖于患者回忆，准确确定抗生素使用史具有挑战性。通过使用韩国药物利用审查（DUR）系统确定大环内酯暴露情况，我们分析了以前使用大环内酯对抗生素耐药性的影响，并比较了基于大环内酯暴露史的定制治疗和经验治疗的根除率。方法选取2021年至2023年同意通过健康保险审查和评估服务DUR系统获取处方信息的确诊幽门螺杆菌感染患者。患者接受了量身定制的治疗，即在没有大环内酯暴露的病例中采用克拉霉素（CLR）三联治疗，在大环内酯暴露的病例中采用铋四联治疗。同时前瞻性招募经验治疗组，比较根除率。结果共418例患者(定制治疗组，n = 57；经验治疗组（n = 361）。在定制治疗组中，近5年服用大环内酯类抗生素的占24.6%。既往使用大环内酯类药物的患者的CLR耐药率高于未使用大环内酯类药物的患者（66.7% vs. 7.5%, p < 0.001）。在意向治疗（ITT）、改良意向治疗（MITT）和每个方案（PP）分析中，定制治疗组的根除率高于经验治疗组(ITT, 86.0% vs. 75.6%；MITT， 94.2%对80.3%；PP, 94.2% vs. 85.1%)。结论先前使用DUR系统识别的大环内酯暴露与较高的CLR耐药率相关。与经验治疗相比，基于大环内酯暴露史的量身定制治疗导致更高的根除率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Helicobacter 医学-微生物学

CiteScore

8.40

自引率

9.10%

发文量

审稿时长

2 months

期刊介绍： Helicobacter is edited by Professor David Y Graham. The editorial and peer review process is an independent process. Whenever there is a conflict of interest, the editor and editorial board will declare their interests and affiliations. Helicobacter recognises the critical role that has been established for Helicobacter pylori in peptic ulcer, gastric adenocarcinoma, and primary gastric lymphoma. As new helicobacter species are now regularly being discovered, Helicobacter covers the entire range of helicobacter research, increasing communication among the fields of gastroenterology; microbiology; vaccine development; laboratory animal science.