Chuah Seng-Kee, Tai Wei-Chen, Lee Chen-Hsiang, Liang Chih-Ming, Hu Tsung-Hui
Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Ta-Pei Road, Niao-Sung District, Kaohsiung 833, Taiwan.
Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Ta-Pei Road, Niao-Sung District, Kaohsiung 833, Taiwan.
Biomed Res Int. 2014;2014:151543. doi: 10.1155/2014/151543. Epub 2014 Aug 28.
Fluoroquinolones, especially levofloxacin, are used in the eradication of Helicobacter pylori worldwide. Many consensus guidelines recommend that the second-line rescue therapy for H. pylori eradication consists of a proton pump inhibitor, a quinolone, and amoxicillin as an option. Unfortunately, quinolone is well associated with a risk of developing bacterial resistance. In this paper, we review quinolone-containing H. pylori eradication regimens and the challenges that influence the efficacy of eradication. It is generally suggested that the use of levofloxacin should be confined to "rescue" therapy only, in order to avoid a further rapid increase in the resistance of H. pylori to quinolone. The impact of quinolone-containing H. pylori eradication regimens on public health issues such as tuberculosis treatment must always be taken into account. Exposure to quinolone is relevant to delays in diagnosing tuberculosis and the development of drug resistance. Extending the duration of treatment to 14 days improves eradication rates by >90%. Tailored therapy to detect fluoroquinolone-resistant strains can be done by culture-based and molecular methods to provide better eradication rates. Molecular methods are achieved by using a real-time polymerase chain reaction to detect the presence of a gyrA mutation, which is predictive of treatment failure with quinolones-containing triple therapy.
氟喹诺酮类药物，尤其是左氧氟沙星，在全球范围内用于根除幽门螺杆菌。许多共识指南推荐，幽门螺杆菌根除的二线挽救治疗方案可选择质子泵抑制剂、一种喹诺酮类药物和阿莫西林。不幸的是，喹诺酮类药物与细菌耐药风险密切相关。在本文中，我们综述了含喹诺酮类药物的幽门螺杆菌根除方案以及影响根除疗效的挑战。一般建议，左氧氟沙星的使用应仅限于“挽救”治疗，以避免幽门螺杆菌对喹诺酮类药物的耐药性进一步快速上升。含喹诺酮类药物的幽门螺杆菌根除方案对结核病治疗等公共卫生问题的影响必须始终予以考虑。接触喹诺酮类药物与结核病诊断延迟和耐药性发展有关。将治疗时长延长至14天可使根除率提高至90%以上。通过基于培养和分子方法的针对性治疗来检测耐氟喹诺酮菌株，可提高根除率。分子方法是通过实时聚合酶链反应检测gyrA突变的存在来实现的，该突变可预测含喹诺酮类三联疗法的治疗失败。
