Graham David Y, Lu Hong, Yamaoka Yoshio
Helicobacter. 2007 Aug;12(4):275-8. doi: 10.1111/j.1523-5378.2007.00518.x.
Helicobacter pylori causes a serious bacterial infectious disease, and the expectations of therapy should reflect this fact. Increasing antibiotic resistance, especially to clarithromycin, has significantly undermined the effectiveness of legacy triple therapy consisting of a proton pump inhibitor, clarithromycin, and amoxicillin. Current cure rates are consistently below 80% intention-to-treat, the accepted threshold separating acceptable from unacceptable treatment results. Grading clinical studies into effectiveness categories using prespecified criteria would allow clinicians to objectively identify and compare regimens. We offer a therapy report card similar to that used to grade the performance of school children. The intention-to-treat cure rate categories are: F or unacceptable ( 80%), D or poor (81-84%), C or fair (85-89%), B or good (90-95%), and A or excellent (95-100%). The category of "excellent" is based on the cure rates expected with other prevalent bacterial infectious diseases. We propose that only therapies that score "excellent" (grade = A) should be prescribed. Regimens scoring as B or "good" can be used if "excellent" results are not obtainable. In most regions legacy triple therapy should be abandoned as unacceptable. Quadruple therapy and sequential therapy are reasonable alternatives for initial therapy.
幽门螺杆菌会引发一种严重的细菌性传染病，治疗预期应反映这一事实。抗生素耐药性不断增加，尤其是对克拉霉素的耐药性，已严重削弱了由质子泵抑制剂、克拉霉素和阿莫西林组成的传统三联疗法的有效性。目前的意向性治疗治愈率一直低于80%，这是区分可接受与不可接受治疗结果的公认阈值。使用预先设定的标准将临床研究分为不同疗效类别，可使临床医生客观地识别和比较治疗方案。我们提供一份类似于用于给学童成绩打分的治疗报告卡。意向性治疗治愈率类别为：F或不可接受（<80%）、D或差（81 - 84%）、C或一般（85 - 89%）、B或良好（90 - 95%）以及A或优秀（95 - 100%）。“优秀”类别是基于其他常见细菌性传染病预期的治愈率。我们建议仅应开具评为“优秀”（等级 = A）的治疗方案。如果无法获得“优秀”结果，可以使用评为B或“良好”的治疗方案。在大多数地区，传统三联疗法应作为不可接受的疗法而被摒弃。四联疗法和序贯疗法是初始治疗的合理替代方案。
