Gastroenterology Unit, Hospital Universitario de la Princesa and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
Therap Adv Gastroenterol. 2009 Nov;2(6):331-56. doi: 10.1177/1756283X09347109.
Helicobacter pylori infection is the main known cause of gastritis, gastroduodenal ulcer disease and gastric cancer. After more than 20 years of experience in H. pylori treatment, however, the ideal regimen to treat this infection has still to be found. Nowadays, apart from having to know well first-line eradication regimens, we must also be prepared to face treatment failures. Therefore, in designing a treatment strategy we should not focus on the results of primary therapy alone, but also on the final (overall) eradication rate. The choice of a 'rescue' treatment depends on which treatment is used initially. If a first-line clarithromycin-based regimen was used, a second-line metronidazole-based treatment (quadruple therapy) may be used afterwards, and then a levofloxacin-based combination would be a third-line 'rescue' option. Alternatively, it has recently been suggested that levofloxacin-based 'rescue' therapy constitutes an encouraging second-line strategy, representing an alternative to quadruple therapy in patients with previous PPI-clarithromycin-amoxicillin failure, with the advantage of efficacy, simplicity and safety. In this case, quadruple regimen may be reserved as a third-line 'rescue' option. Finally, rifabutin-based 'rescue' therapy constitutes an encouraging empirical fourth-line strategy after multiple previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline, and levofloxacin. Even after two consecutive failures, several studies have demonstrated that H. pylori eradication can finally be achieved in almost all patients if several 'rescue' therapies are consecutively given. Therefore, the attitude in H. pylori eradication therapy failure, even after two or more unsuccessful attempts, should be to fight and not to surrender.
幽门螺杆菌感染是胃炎、胃十二指肠溃疡病和胃癌的主要已知病因。然而，经过 20 多年的幽门螺杆菌治疗经验，仍然需要找到理想的治疗方案来治疗这种感染。如今，除了必须了解一线根除方案外，我们还必须准备好面对治疗失败。因此，在设计治疗策略时，我们不仅要关注初始治疗的结果，还要关注最终（总体）根除率。“补救”治疗的选择取决于最初使用的治疗方法。如果使用了一线克拉霉素为基础的方案，那么可能会随后使用二线以甲硝唑为基础的治疗（四联疗法），然后以左氧氟沙星为基础的联合治疗是三线“补救”选择。或者，最近有人建议，左氧氟沙星为基础的“补救”治疗是一种有前途的二线策略，在以前 PPI-克拉霉素-阿莫西林治疗失败的患者中，代表了四联疗法的替代方案，具有疗效、简单和安全性的优势。在这种情况下，四联疗法可以作为三线“补救”选择保留。最后，利福布汀为基础的“补救”治疗是在多次关键抗生素（如阿莫西林、克拉霉素、甲硝唑、四环素和左氧氟沙星）根除失败后，作为一种有前途的经验性四线策略。即使连续两次失败，几项研究表明，如果连续使用几种“补救”疗法，几乎所有患者最终都可以实现幽门螺杆菌的根除。因此，在幽门螺杆菌根除治疗失败后，即使已经尝试了两次或更多次，也应该采取积极的态度，而不是放弃。
