Wu Tzung-Shiun, Hu Huang-Ming, Kuo Fu-Chen, Kuo Chao-Hung
Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
Kaohsiung J Med Sci. 2014 Apr;30(4):167-72. doi: 10.1016/j.kjms.2013.11.003. Epub 2013 Dec 16.
Eradication of Helicobacter pylori infection has become an important issue recently, because this bacterial species cluster can cause many gastrointestinal diseases. Elevated antibiotic resistance is related to an increasing failure rate of H. pylori eradication. Standard triple therapy is still the first-line therapy; however, according to the Maastricht IV Consensus Report, it should be abandoned in areas of high clarithromycin resistance. Alternative first-line therapies include bismuth-containing quadruple therapy, sequential, concomitant, and hybrid therapies. Quinolone-based triple therapy may be considered as first-line therapy in areas of clarithromycin resistance >15-20% and quinolone resistance <10%. Unique second-line therapy is still unclear, and bismuth-containing quadruple therapy or levofloxacin-based triple therapy can be used as rescue treatment. Third-line therapy should be under culture guidance to select the most effective regimens (such as levofloxacin-based, rifabutin-based, or furazolidone-based therapies). Antibiotics resistance, patient compliance, and CYP 2C19 genotypes could influence the outcome. Clinicians should use antibiotics according to local reports.
根除幽门螺杆菌感染近来已成为一个重要问题，因为这种菌群可引发多种胃肠道疾病。抗生素耐药性升高与幽门螺杆菌根除失败率增加有关。标准三联疗法仍是一线治疗方案；然而，根据《马斯特里赫特IV共识报告》，在克拉霉素高耐药地区应摒弃该疗法。替代一线疗法包括含铋四联疗法、序贯疗法、联合疗法和混合疗法。在克拉霉素耐药率>15 - 20%且喹诺酮耐药率<10%的地区，基于喹诺酮的三联疗法可被视为一线疗法。独特的二线疗法仍不明确，含铋四联疗法或基于左氧氟沙星的三联疗法可用作补救治疗。三线疗法应在培养指导下选择最有效的方案（如基于左氧氟沙星、利福布汀或呋喃唑酮的疗法）。抗生素耐药性、患者依从性和CYP 2C19基因型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。
