INSERM U853; Bordeaux, France; Université de Bordeaux; Laboratoire de Bactériologie; Bordeaux, France.
Gut Microbes. 2013 Nov-Dec;4(6):541-8. doi: 10.4161/gmic.25930. Epub 2013 Aug 5.
Occurrence of resistance, especially to clarithromycin, renders the standard triple therapy used to cure Helicobacter pylori infection ineffective. This review presents the bacteriological and pharmacological basis for H. pylori therapy and the current recommendations. The third-line treatment must be based on clarithromycin susceptibility testing. If the bacteria are still susceptible, failure may come from problems of compliance, hyperacidity or high bacterial load which can be overcome. If the bacteria are resistant, different regimens must be considered, including bismuth and non-bismuth-based quadruple therapies (sequential or concomitant), as well as triple therapies where amoxicillin is administered several times a day to obtain an optimal concentration at the gastric mucosal level. The treatments are becoming more and more complex and ecologically unsatisfactory, waiting for new agents or vaccines.
耐药性的出现，尤其是对克拉霉素的耐药性，使得用于治疗幽门螺杆菌感染的标准三联疗法无效。本综述介绍了幽门螺杆菌治疗的细菌学和药理学基础以及当前的建议。三线治疗必须基于克拉霉素药敏试验。如果细菌仍然敏感，失败可能来自于依从性、胃酸过高或细菌负荷过高的问题，这些问题可以得到克服。如果细菌耐药，必须考虑不同的方案，包括含铋和不含铋的四联疗法（序贯或同时），以及每天多次给予阿莫西林的三联疗法，以在胃黏膜水平获得最佳浓度。治疗方法变得越来越复杂，生态上也不尽如人意，正在等待新的药物或疫苗。
