Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University of Magdeburg, Germany.
Curr Opin Gastroenterol. 2011 Oct;27(6):565-70. doi: 10.1097/MOG.0b013e32834bb818.
The article will give an overview on reasons for treatment failure and tries to show new concepts for Helicobacter pylori treatment.
Several new treatment options or modifications of already established regimens have been introduced to overcome treatment failure. Antibiotic resistance to H. pylori is the key factor for treatment failure. At the moment, standard triple therapy remains the primary choice in regions with proven low clarithromycin resistance rates. In areas with high clarithromycin resistance, four drug treatment regimens, including quadruple and sequential therapy, have proven the best results as first-line regimens. The options for second-line treatment regimens are manifold. Second-line treatment regimens need to be adapted accurately to local resistance rates.
Treatment of H. pylori infection is challenged by a dramatic fall in eradication rates all over the world. Newer regimens have been introduced including sequential, quadruple therapies and those regimens provide promising results, but the knowledge about local resistance rates remains the key to an effective therapy.
本文将概述治疗失败的原因，并试图展示幽门螺杆菌治疗的新概念。
为了克服治疗失败，已经引入了几种新的治疗选择或已经确立方案的修改。幽门螺杆菌的抗生素耐药性是治疗失败的关键因素。目前，在已经证实克拉霉素耐药率低的地区，标准三联疗法仍然是首选。在克拉霉素耐药率高的地区，包括四联和序贯疗法在内的四种药物治疗方案已被证明是作为一线方案的最佳选择。二线治疗方案的选择多种多样。二线治疗方案需要根据当地耐药率进行准确调整。
全世界的幽门螺杆菌根除率急剧下降，对幽门螺杆菌感染的治疗提出了挑战。已经引入了新的方案，包括序贯疗法、四联疗法，这些方案提供了有希望的结果，但对当地耐药率的了解仍然是有效治疗的关键。
