Lee Ju Yup, Park Kyung Sik
Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea.
Gastroenterol Res Pract. 2016;2016:9086581. doi: 10.1155/2016/9086581. Epub 2016 Dec 13.
A new treatment strategy is needed, as the efficacy of triple therapy containing clarithromycin-the current standard treatment for infection-is declining. Increasing antibiotic resistance of is the most significant factor contributing to eradication failure. Thus, selecting the most appropriate regimen depending on resistance is optimal, but identifying resistance to specific antibiotics is clinically challenging. In a region suspected to have high clarithromycin resistance, bismuth quadruple therapy and so-called nonbismuth quadruple therapies (sequential, concomitant, and sequential-concomitant hybrid) are some first-line regimen options. However, more research is needed regarding appropriate second-line treatments after first-line treatment failure. Tailored therapy, which is based on antibiotic sensitivity testing, would be optimal but has several limitations for clinical use, and an alternative technique is required. A novel potassium-competitive acid blocker-based eradication regimen could be a valuable eradication option in the near future.
由于目前针对感染的标准治疗方法——含克拉霉素的三联疗法的疗效正在下降，因此需要一种新的治疗策略。幽门螺杆菌抗生素耐药性增加是导致根除失败的最主要因素。因此，根据耐药性选择最合适的治疗方案是最佳选择，但在临床上确定对特定抗生素的耐药性具有挑战性。在怀疑克拉霉素耐药性较高的地区，铋剂四联疗法以及所谓的非铋剂四联疗法（序贯、联合和序贯-联合混合疗法）是一些一线治疗方案选择。然而，对于一线治疗失败后的合适二线治疗方法，还需要更多的研究。基于抗生素敏感性测试的个体化治疗将是最佳选择，但在临床应用中有几个局限性，因此需要一种替代技术。一种新型的基于钾离子竞争性酸阻滞剂的根除方案在不久的将来可能会成为一种有价值的根除选择。
