| ?Objective?With the increasing resistance of Helicobacter pylori(Hp)to conventional antibiotics,the eradication rate of Hp by empirical treatment has decreased.In order to improve the eradication rate of Hp,this study summarizes the epidemiological characteristics of Hp in the region and analyzes the effect of directing precise clinical treatment of Hp under drug sensitivity detection to improve the eradication rate of Hp.?Method?1.This study selected February 2018 to June 2019 due to long-term symptoms of upper gastrointestinal discomfort 159 patients,who came to our hospital for Helicobacter pylori outpatient examination for a positive breath test.It is recommended that patients undergo gastroscopy and successfully undergo gastroscopy.Patients entered the study.Tissue and mucosal specimens of the gastric body and antrum of the patient were clipped under a gastroscope for Hp solid culture,isolation,and purification,and 63 H.pylori strains were finally obtained.2.The sensitivity of 63 clinical isolates to amoxicillin,levofloxacin and furazolidone,clarithromycin,and metronidazole was detected by the paper diffusion method and the sensitivity was analyzed.3.For the 63 patients with Helicobacter pylori culture,they were randomly divided into two groups,drug sensitivity A and B.Drug sensitivity A group used:PPI+bismuth agent+2 kinds of sensitive antibiotics with the largest diameter of inhibition zone;drug sensitivity B The group used:PPI+bismuth agent+1 sensitive antibiotics with the largest diameter of bacteriostatic circle.For another 96 patients with positive outpatient breath test and parallel gastroscopy but no H.pylori culture,these patients were used as the empirical treatment group,and they were randomly divided into two groups:experience C and D,and experience C Use:PPI+bismuth agent+clarithromycin+amoxicillin program;experience D group:PPI+bismuth agent+clarithromycin+metronidazole.Oral drug dose:omeprazole(PPI),taken orally half an hour before a meal,1 capsule twice a day;bismuth potassium citrate,taken orally a half an hour before a meal,2 capsules twice daily;Amoclinin,taken orally half an hour after a meal,2 capsules,twice daily;levofloxacin,taken orally a half hour after a meal,1 capsule once a day,furazolidone,orally taken half an hour after a meal,1capsule daily 2 times;clarithromycin,orally,1 capsule,half a day after a meal,2times a day;metronidazole,oral,1 capsule,half a day after a meal,once a day;14consecutive days.Four weeks after the anti-Hp treatment was discontinued,the ~144 C breath test was reviewed.Comparison of the efficacy of empirical treatment and drug sensitivity testing for the eradication of Helicobacter pylori.?Result?1.The 63 resistant strains of Helicobacter pylori isolates to amoxicillin,levofloxacin,furazolidone,clarithromycin,and metronidazole were 4.8%,27.0%,14.3%,47.6%,and 85.7%,respectively.The difference in rates is of statistical significance;the resistance rates of metronidazole,clarithromycin,and levofloxacin were significantly higher in patients treated with anti-Hp than in untreated patients;there was no difference in drug resistance rates among different disease types.The resistance rate of metronidazole in female patients was higher than that in male patients.The resistance rates of the other four antibiotics were not different among patients of different sexes.2.According to the results of the study,the eradication rate of drug sensitivity group A was 92.86%(26/28),which was significantly higher than that of the C and D groups treated by experience.The difference in eradication was statistically significant(P<0.05);Comparison between groups and B found that the eradication rate of drug-sensitive A group was 92.86%(26/28)and the eradication rate of drug-sensitive B group was 69.23%(18/26).There was a statistical difference between the two groups(P<0.05);In addition,the comparison between experience group C and D found that the eradication rate of experience group C was 76.92%(30/39)and the eradication rate of experience group D was 72.22%(26/36).There was no statistical difference between the two(P>0.05).?conclusion?1.Currently in this area The rate of resistance to metronidazole in the treatment of pylori is very high,and metronidazole should not be used as a first-line drug in clinical practice.2.This study found that The resistance rates of pylori to clarithromycin and levofloxacin have been relatively high;the resistance rates to amoxicillin and furazolidone are relatively low,which can be used as an empirical eradication.main drugs of pylori;3.This study found that the eradication rate of the two sensitive antibiotics H.pylori under the guidance of accurate drug sensitivity testing was higher than that of one sensitive antibiotic and empirical treatment.4.Bacterial culture plus drug susceptibility testing has important guiding significance for accurate eradication of Hp,and Hp drug susceptibility testing should be carried out as far as possible under conditions. |
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