Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City 807, Taiwan.
Gastroenterol Res Pract. 2012;2012:168361. doi: 10.1155/2012/168361. Epub 2012 Jun 27.
This paper reviews the literature about first-line therapies for H. pylori infection in recent years. First-line therapies are facing a challenge because of increasing treatment failure due to elevated antibiotics resistance. Several new treatment strategies that recently emerged to overcome antibiotic resistance have been surveyed. Alternative first-line therapies include bismuth-containing quadruple therapy, sequential therapy, concomitant therapy, and hybrid therapy. Levofloxacin-based therapy shows impressive efficacy but might be employed as rescue treatment due to rapidly raising resistance. Rifabutin-based therapy is also regarded as a rescue therapy. Several factors including antibiotics resistance, patient compliance, and CYP 2C19 genotypes could influence the outcome. Clinicians should use antibiotics according to local reports. It is recommended that triple therapy should not be used in areas with high clarithromycin resistance or dual clarithromycin and metronidazole resistance.
本文综述了近年来幽门螺杆菌感染的一线治疗方法。由于抗生素耐药性的增加，一线治疗方法面临着治疗失败率上升的挑战。最近出现了几种新的治疗策略来克服抗生素耐药性，本文对这些策略进行了调查。替代一线治疗包括含铋四联疗法、序贯疗法、同时疗法和混合疗法。基于左氧氟沙星的治疗方案显示出令人印象深刻的疗效，但由于耐药性迅速上升，可能被用作挽救治疗。利福布汀治疗也被认为是一种挽救治疗。包括抗生素耐药性、患者依从性和 CYP2C19 基因型在内的几个因素可能会影响治疗结果。临床医生应根据当地报告使用抗生素。建议在克拉霉素耐药率高或双重克拉霉素和甲硝唑耐药的地区不要使用三联疗法。
