H. pylori: Implicações atuais e a resistência à terapia antimicrobiana – revisão de literatura
Treatment and therapeutic resistance of H. pylori: review of literature
Thiago Celeira de Sousa, Ursula Tatiane de Farias Hounsell Almeida, Dauana Arruda de Oliveira Bastos
Resumo
Objetivo: Realizar uma revisão sobre os tratamentos e a resistência do H. pylori. Método: A pesquisa foi desenvolvida no período de Fevereiro a Junho de 2018, e realizada a partir das bases de dados: Medline, SciELO, LILACS, PubMed, e Bireme por meio dos descritores: Helicobacter Pylori, Resistência Antimicrobiana, Prevalência e Câncer Gástrico. Resultados: A busca por literatura produziu um total de 85 artigos que foram submetidos a avaliação por dois avaliadores independentes. Destes, 20 atenderam critérios de inclusão previamente estabelecidos. Conclusão: A totalidade dos estudos envolvidos nesta pesquisa nos mostram uma elevada prevalência da infecção por H. pylori e alta taxa de resistência para muitos antibióticos, tendo isto um impacto preocupante em um continente com áreas de alta prevalência de contaminação e também com altas taxas de incidência de doenças graves relacionadas a infecção, como lesões pré-neoplásicas e o adenocarcinoma gástrico. As taxas de resistência á claritomicina variaram entre 11,1% a 47% nos resultados dos artigos selecionados para este estudo, sendo portando o antimicrobiano que apresentou a maior taxa de resistência. Em relação ao tratamento, os 3 principais guidelines utilizados (Colégio Americano, Consenso Brasileiro e Consenso Europeu) concordam em relação á primeira linha de tratamento, porém os consensos Europeu e Americano propõem o uso de metronidazol como alternativa á amoxicilina nesta linha de tratamento.
Palavras-chave
Abstract
Purpose: Reviewer of the treatments and resistance of H. pylori. Method: The research was carried from February to June 2018, and performed from the databases: Medline, SciELO, LILACS, PubMed, and Bireme by means of the descriptors: Helicobacter Pylori, Antimicrobial Resistance, Prevalence and Gastric Cancer. Results: The search for literature produced a total of 85 articles that were submitted to evaluation by two independent evaluators. Of these, 20 met previously established inclusion criteria. Conclusion: All the studies involved in this study show a high prevalence of H. pylori infection and a high resistance rate for many antibiotics. This has a worrying impact in a continent with areas of high contamination prevalence and also with high rates of incidence of serious infection-related diseases such as pre-neoplastic lesions and gastric adenocarcinoma. The rates of resistance to clarithromycin ranged from 11.1% to 47% in the results of the articles selected for this study, with the antimicrobial having the highest resistance rate. Regarding treatment, the 3 main guidelines used (American College, Brazilian Consensus and European Consensus) agree on the first line of treatment, but the European and American consensus proposes the use of metronidazole as an alternative to amoxicillin in this treatment line.
Keywords
Referências
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