Vaira Dino, Zullo Angelo, Ricci Chiara, Gigliotti Francesca, Morini Sergio
Dipartimento di Medicina Interna e Gastroenterologia, Università, Bologna.
Recenti Prog Med. 2007 Nov;98(11):574-82; quiz 602.
H. pylori eradication following standard triple therapies is decreasing worldwide, mainly due to an increased prevalence of bacterial resistance against antibiotics. Therefore, to cure such an infection remains a challenge for clinicians. This paper aimed to review the currently available therapeutic approaches, for which large and consistent data exist in literature, in order to update H. pylori management in the clinical practice. According to the updated European Guidelines, the first-line therapy should be chosen based on the prevalence of clarithromycin resistance. A 7-day triple therapy should be employed if clarithromycin resistance is lower than 15-20%, whilst this regimen should be prolonged to 14 days where resistance is higher. A 7-day quadruple therapy is suggested as second-line treatment. However, quadruple therapy is no more available in Italy. According to the forthcoming Italian Guidelines, a new "therapeutic package" could be used, including a 10-day sequential regimen as first-line therapy and a 10-day levofloxacin-based regimen as re-treatment. The sequential regimen (5-day dual plus 5-day triple therapy) achieved an eradication rate constantly >90% in several Italian studies, being more effective than standard triple therapy, even in patients with clarithromycin resistant strains.
在全球范围内，采用标准三联疗法根除幽门螺杆菌的成功率正在下降，主要原因是细菌对抗生素的耐药性日益普遍。因此，治愈这种感染对临床医生来说仍然是一项挑战。本文旨在回顾文献中存在大量一致数据的现有治疗方法，以便在临床实践中更新幽门螺杆菌的管理。根据最新的欧洲指南，一线治疗应根据克拉霉素耐药率来选择。如果克拉霉素耐药率低于15%-20%，应采用7天三联疗法，而当耐药率较高时，该方案应延长至14天。建议采用7天四联疗法作为二线治疗。然而，在意大利已不再有四联疗法。根据即将出台的意大利指南，可使用一种新的“治疗套餐”，包括作为一线治疗的10天序贯疗法和作为再治疗的10天左氧氟沙星疗法。在意大利的多项研究中，序贯疗法（5天双联疗法加5天三联疗法）的根除率持续>90%；即使对于携带克拉霉素耐药菌株的患者，序贯疗法也比标准三联疗法更有效。
