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UvA-DARE ( Digital Academic Repository ) Helicobacter pylori in the critically ill patient
| Content Provider | Semantic Scholar |
|---|---|
| Author | Voort, Van Der Ph, Jung Link |
| Copyright Year | 2012 |
| Abstract | Background: Resistance to systemically applied antibiotics is emerging in Helicobacter pylori infection. Topically applied antibiotics have not been studied extensively in the treatment of H. pylori infection. In a previous study we have shown that H. pylori was effectively suppressed by selective decontamination of the digestive tract (SDD) during intensive care stay. In the present study we determined the susceptibility of H. pylori to the topically applied antibiotics used in SDD in vitro and in vivo. Methods: H. pylori infection was assessed by Laser-assisted-ratio-analyser (LARA)-C-urea breath test and detection of H. pylori antibodies in patients' serum. The in vivo susceptibility of H. pylori to the SDD antibiotics was assessed in two ways: 1) Ten critically ill H. pylori positive patients were treated with SDD, comprising intravenous cefotaxime and 3 topical antibiotics (polymyxin, tobramycin and amphotericin B) administered via a nasogastric tube. 2) Six H. pylori positive volunteers were treated with the topical antibiotics without intravenous cefotaxime to determine the effect of the topical antibiotics alone on H. pylori. The in vitro susceptibility to the SDD antibiotics and other antibiotics that are frequently used in the intensive care unit was studied for 11 H. pylori strains, obtained from critically ill patients. Results: Conversion from a positive into a negative LARA-C-urea breath test within 7 days of SDD treatment occurred in nine of ten critically ill patients. In all 6 volunteers who were treated with the topical antibiotics alone, the LARA-C-urea breath test converted from positive to negative test after 7 days. Eight weeks after cessation of the topical antibiotics, 5 of the 6 volunteers re-converted from a negative to a positive LARA-C-urea breath test. The critically ill patients did not convert into a positive test as long as the SDD treatment was continued. The in vitro studies revealed that all strains were susceptible for cefotaxime and tobramycin, indicating that both antibiotics caused the suppression of H. pylori in the critically ill patients but tobramycin alone in volunteers. The strains were not susceptible for polymyxin or amphotericin B. Conclusion: H. pylori was effectively suppressed by the SDD regimen, containing both intravenous cefotaxime and topical tobramycin. Topical tobramycin alone could suppress H. pylori in all cases but a recrudescence occurred frequently after cessation of treatment. |
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| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
