Nazlı Arslan, Özlem Yılmaz, Ebru Demiray-Gürbüz, Department of Medical Microbiology, Faculty of Medicine, Dokuz Eylül University, Inciraltı, Izmir 35340, Turkey.
World J Gastroenterol. 2017 Apr 28;23(16):2854-2869. doi: 10.3748/wjg.v23.i16.2854.
The management of () infection treatment differs from the common treatment protocol for other infectious diseases. Because culture- or molecular-guided approaches face several practical issues, such as the invasive procedures required to obtain gastric biopsy specimens and the lack of availability of routine laboratory testing in some places, treatment includes the administration of two or three empirically selected antibiotics combined with a proton pump inhibitor rather than evidence-based eradication treatment. The efficacy of empirical therapy is decreasing, mostly due to increasing multiple resistance. Multiresistance to levofloxacin, clarithromycin, and metronidazole, which are commonly used in empirical treatments, appears to have increased in many countries. Mutations play a primary role in the antimicrobial resistance of , but many different mechanisms can be involved in the development of antibiotic resistance. Determining and understanding these possible mechanisms might allow the development of new methods for the detection of and the determination of antimicrobial resistance. A treatment based on the detection of antimicrobial resistance is usually more effective than empirical treatment. Nevertheless, such an approach before treatment is still not recommended in the Maastricht guidelines due to the difficulty associated with the routine application of available culture- or molecular-based susceptibility tests, which are usually administered in cases of treatment failure. The management of first and rescue treatments requires further research due to the steadily increase in antimicrobial resistance.
()感染的治疗管理与其他传染病的常规治疗方案不同。由于基于培养或分子的方法面临着一些实际问题，例如获得胃活检标本所需的侵入性程序，以及在某些地方缺乏常规实验室检测，因此治疗包括给予两种或三种经验性选择的抗生素联合质子泵抑制剂，而不是基于证据的根除治疗。经验性治疗的疗效正在下降，主要是由于多重耐药性的增加。在许多国家，普遍用于经验性治疗的左氧氟沙星、克拉霉素和甲硝唑的多耐药性似乎有所增加。突变在 对抗菌药物耐药性中起主要作用，但在抗生素耐药性的发展中可能涉及许多不同的机制。确定和了解这些可能的机制可能有助于开发新的方法来检测 和确定抗菌药物耐药性。基于检测抗菌药物耐药性的治疗通常比经验性治疗更有效。然而，由于常规应用现有的基于培养或分子的药敏试验存在困难，这些试验通常在治疗失败时进行，因此马斯特里赫特指南不建议在治疗前采用这种方法。由于抗菌药物耐药性的稳步增加，首次和挽救治疗的管理需要进一步研究。
