胃幽門螺旋桿菌（Helicobacter pylori）為螺旋狀微好氧的革蘭氏陰性菌，寄生於人類的胃表皮黏膜上。流行病學上，感染胃幽門螺旋桿菌與許多疾病的發生有正相關性。目前治療胃幽門螺旋桿菌感染是採用抗生素合併其他藥物治療，而已知胃幽門螺旋桿菌的抗藥性為治療失敗的一大主因。本研究之目的在於調查台灣地區胃幽門螺旋桿菌感染之治癒成效與胃幽門螺旋桿菌對metronidazole，clarithromycin，以及amoxicillin三種抗生素的抗藥性出現比率，並與其他國家之情形做比較。結果發現，在收集經過LAC與LMC完整治療的137位病人中，胃幽門螺旋桿菌的治癒率分別為88.41%以及85.29%。而此由兩種治療方式之病人體內取得的胃幽門螺旋桿菌，其metronidazole和clarithromycin之抗藥性比率分別為39.29%，43.48%以及7.14%，4.35%。在本研究中，沒有發現任何菌株有amoxicillin抗藥性。另一方面，我們也探討了治療失敗的原因。利用PCR-RFLP來檢定由治療失敗的病人體內取得之胃幽門螺旋桿菌菌株，在治療前後是否為同一菌株。最小抑菌濃度（MIC）則利用E-test方式測出。此外，我們也對於metronidazole以及clarithromycin的抗藥性基因做了分析。由結果顯示，在接受LAC治療後失敗的八位病人中發現兩起重複感染的案例，其餘大多數菌株則是具有metronidazole或clarithromycin或同時具有此兩種抗藥性存在。在基因分析結果中，我們發現有一菌株在rdxA基因中具有三個胺基酸的缺失，此項情形尚未見於其他相關報導中。

Helicobacter pylori is a Gram-negative microaerophilic bacterium which colonizes the gastric mucosa of the human stomach. Infection with H. pylori is associated with gastritis, gastric ulcer, duodenal ulcer. The common treatment of H. pylori infection includes antibiotics and a combination of a proton pump inhibitor. Because of an increased use of antibiotic agents, resistance to antibiotics is the major cause of the therapy failure. The aim of this study is to investigate the efficacy of the triple therapy and the prevalence of the resistance of the three antibiotics used in eradication therapy, which are metronidazole, clarithromycin, and amoxicillin. 151 patients who took the triple therapies containing lansoprazole, clarithromycin, and metronidazole/amoxicillin in Taichung Veterans General Hospital were enrolled in this study and 137 patients completed the course of treatment. The resistance of fifty-one strains collected from patients in 2000 were determined by its minimal inhibitory concentration (MIC) values of the three antibiotics, which were determined by E-test. Two regimens were used in this study: the eradication rate of the LAC regimen total is 88.41% and it is 85.29% in LMC regimen. In LAC regimen, the prevalence of resistance of metronidazole and clarithromycin is 39.29% and 7.14% respectively. In LMC regimen, the prevalence of these two antibiotics are 43.48% and 4.35%. No amoxicillin-resistant strains are found in this study. Eighteen different strains from fifteen patients were analyzed for the reason of therapy failure. The strains were examined by polymerase chain reaction (PCR) and PCR-based restriction fragment length polymorphism (RFLP) of the vacA and ureA-ureB genes to examine whether the strains obtained before and after treatment are the same. Their MIC values were also determined by E-test. The rdxA and 23s rRNA genes from both antibiotic resistant and sensitive strains were sequenced to investigate the difference between those strains. We find that there are two re-infection cases in LAC regimen and six different strains six patients are resistant to metronidazole or clarithromycin and four different strains from four patients are resistant to both metronidazole and clarithromycin. In the gene analysis, most our data correspond with published data. We also find one interesting strain has the three amino acids deletion in its rdxA gene, which is not seen in other data.

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