Division of Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 833 Kaohsiung, Taiwan.
World J Gastroenterol. 2011 Sep 21;17(35):3971-5. doi: 10.3748/wjg.v17.i35.3971.
With the rising prevalence of antimicrobial resistance, the treatment success of standard triple therapy has recently declined to unacceptable levels (i.e., 80% or less) in most countries. Therefore, several treatment regimens have emerged to cure Helicobacter pylori (H. pylori) infection. Novel first-line anti-H. pylori therapies in 2011 include sequential therapy, concomitant quadruple therapy, hybrid (dual-concomitant) therapy and bismuth-containing quadruple therapy. After the failure of standard triple therapy, a bismuth-containing quadruple therapy comprising a proton pump inhibitor (PPI), bismuth, tetracycline and metronidazole can be employed as rescue treatment. Recently, triple therapy combining a PPI, levofloxacin and amoxicillin has been proposed as an alternative to the standard rescue therapy. This salvage regimen can achieve a higher eradication rate than bismuth-containing quadruple therapy in some regions and has less adverse effects. The best second-line therapy for patients who fail to eradicate H. pylori with first-line therapies containing clarithromycin, amoxicillin and metronidazole is unclear. However, a levofloxacin-based triple therapy is an accepted rescue treatment. Most guidelines suggest that patients requiring third-line therapy should be referred to a medical center and treated according to the antibiotic susceptibility test. Nonetheless, an empirical therapy (such as levofloxacin-based or furazolidone-based therapies) can be employed to terminate H. pylori infection if antimicrobial sensitivity data are unavailable.
随着抗菌药物耐药性的不断上升，标准三联疗法的治疗成功率在最近已降至许多国家无法接受的水平（即 80%以下）。因此，出现了几种治疗方案来治愈幽门螺杆菌（H. pylori）感染。2011 年新的一线抗 H. pylori 治疗方法包括序贯疗法、同时四联疗法、混合（双重同时）疗法和含铋四联疗法。在标准三联疗法失败后，可以采用包含质子泵抑制剂（PPI）、铋剂、四环素和甲硝唑的含铋四联疗法作为补救治疗。最近，提出了一种三联疗法，即 PPI、左氧氟沙星和阿莫西林联合治疗，作为标准补救治疗的替代方案。在一些地区，这种挽救方案的根除率高于含铋四联疗法，且不良反应较少。对于一线治疗中含有克拉霉素、阿莫西林和甲硝唑而未能根除 H. pylori 的患者，最佳二线治疗方法尚不清楚。然而，基于左氧氟沙星的三联疗法是一种可接受的补救治疗。大多数指南建议，对需要三线治疗的患者应转至医疗中心，并根据抗生素药敏试验进行治疗。然而，如果没有抗菌药物敏感性数据，可以采用经验性治疗（如基于左氧氟沙星或呋喃唑酮的治疗）来终止 H. pylori 感染。
