Papastergiou Vasilios, Georgopoulos Sotirios D, Karatapanis Stylianos
Vasilios Papastergiou, Stylianos Karatapanis, Department of Internal Medicine, General Hospital of Rhodes, 85100 Rhodes, Greece.
World J Gastrointest Pathophysiol. 2014 Nov 15;5(4):392-9. doi: 10.4291/wjgp.v5.i4.392.
Helicobacter pylori (H. pylori) is a major human pathogen associated with significant morbidity and mortality. However, after decades of efforts, treatment of H. pylori remains a challenge for physicians, as there is no universally effective regimen. Due to the rising prevalence of antimicrobial resistance, mainly to clarithromycin, efficacy of standard triple therapies has declined to unacceptably low levels in most parts of the world. Novel regimens, specifically experimented to improve the therapeutic outcome against antibiotic-resistant H. pylori strains, are now recommended as first-line empirical treatment options providing high efficacy (reportedly > 90% in intention to treat analysis) even in high clarithromycin resistance settings. These include the bismuth quadruple, concomitant, sequential and hybrid therapies. Due to the rapid development of quinolone resistance, levofloxacin-based regimens should be reserved as second-line/rescue options. Adjunct use of probiotics has been proposed in order to boost eradication rates and decrease occurrence of treatment-related side effects. Molecular testing methods are currently available for the characterization of H. pylori therapeutic susceptibility, including genotypic detection of macrolide resistance and evaluation of the cytochrome P450 2C19 status known to affect the metabolism of proton pump inhibitors. In the future, use of these techniques may allow for culture-free, non-invasive tailoring of therapy for H. pylori infection.
幽门螺杆菌（H. pylori）是一种主要的人类病原体，与显著的发病率和死亡率相关。然而，经过数十年的努力，幽门螺杆菌的治疗对医生来说仍然是一项挑战，因为没有一种普遍有效的治疗方案。由于抗菌药物耐药性的不断上升，主要是对克拉霉素的耐药性，标准三联疗法的疗效在世界大部分地区已降至不可接受的低水平。专门为提高对抗生素耐药幽门螺杆菌菌株的治疗效果而试验的新方案，现在被推荐作为一线经验性治疗选择，即使在克拉霉素高耐药环境中也能提供高疗效（据报道，意向性治疗分析中>90%）。这些方案包括铋剂四联疗法、联合疗法、序贯疗法和混合疗法。由于喹诺酮耐药性的迅速发展，基于左氧氟沙星的方案应保留作为二线/挽救方案。有人提出辅助使用益生菌以提高根除率并减少治疗相关副作用的发生。目前有分子检测方法可用于表征幽门螺杆菌的治疗敏感性，包括大环内酯耐药性的基因分型检测以及对已知影响质子泵抑制剂代谢的细胞色素P450 2C19状态的评估。未来，使用这些技术可能允许对幽门螺杆菌感染进行无培养、非侵入性的个体化治疗。
