Mascellino Maria Teresa, Porowska Barbara, De Angelis Massimiliano, Oliva Alessandra
Department of Public Health and Infectious Diseases.
Department of Cardio-Thoracic, Vascular, General Surgery and of Organ Transplants, Policlinico Umberto I, Rome, Italy.
Drug Des Devel Ther. 2017 Jul 28;11:2209-2220. doi: 10.2147/DDDT.S136240. eCollection 2017.
In this review, we discuss the problem of antibiotic resistance, heteroresistance, the utility of cultures and antibiotic susceptibility tests in () eradication, as well as the updated treatment strategies for this infection. The prevalence of antibiotic resistance is increasing all over the world, especially for metronidazole and clarithromycin, because of their heavy use in some geographical areas. Heteroresistance (simultaneous presence of both susceptible and resistant strains in different sites of a single stomach) is another important issue, as an isolate could be mistakenly considered susceptible if a single biopsy is used for antimicrobial tests. We also examined literature data regarding eradication success rates of culture-guided and empiric therapies. The empiric therapy and the one based on susceptibility testing, in eradication, may depend on several factors such as concomitant diseases, the number of previous antibiotic treatments, differences in bacterial virulence in individuals with positive or negative cultures, together with local antibiotic resistance patterns in real-world settings. Updated treatment strategies in infection presented in the guidelines of the Toronto Consensus Group (2016) are reported. These suggest to prolong eradication therapy up to 14 days, replacing the old triple therapy with a quadruple therapy based on proton pump inhibitor (PPI), bismuth, metronidazole, and tetracycline for most of the patients, or as an alternative quadruple therapy without bismuth, based on the use of PPI, amoxicillin, metronidazole, and clarithromycin. The new drug vonoprazan, a first-in-class potassium-competitive acid blocker recently approved in Japan, is also considered to be a promising solution for eradication, even for clarithromycin-resistant strains. Furthermore, there is growing interest in finding new therapeutic strategies, such as the development of vaccines or the use of natural resources, including probiotics, plants, or nutraceuticals.
在本综述中，我们讨论了抗生素耐药性、异质性耐药问题、培养及抗生素敏感性试验在（）根除中的作用，以及针对该感染的最新治疗策略。由于在某些地理区域大量使用，抗生素耐药性在全球范围内呈上升趋势，尤其是对甲硝唑和克拉霉素。异质性耐药（在单个胃部的不同部位同时存在敏感菌株和耐药菌株）是另一个重要问题，因为如果仅用一次活检进行抗菌测试，分离株可能会被错误地认为是敏感的。我们还研究了有关培养指导疗法和经验性疗法根除成功率的文献数据。在（）根除中，经验性疗法和基于药敏试验的疗法可能取决于多种因素，如合并疾病、既往抗生素治疗次数、培养结果为阳性或阴性的个体中细菌毒力的差异，以及现实环境中的局部抗生素耐药模式。报告了多伦多共识小组（2016年）指南中提出的（）感染的最新治疗策略。这些策略建议将根除治疗延长至14天，对于大多数患者，用基于质子泵抑制剂（PPI）、铋剂、甲硝唑和四环素的四联疗法取代旧的三联疗法，或者作为替代方案，使用不含铋剂的四联疗法，即基于PPI、阿莫西林、甲硝唑和克拉霉素。新型药物沃克，一种最近在日本获批的一流钾竞争性酸阻滞剂，也被认为是（）根除的一种有前景的解决方案，即使对于克拉霉素耐药菌株也是如此。此外，人们越来越关注寻找新的治疗策略，如开发疫苗或利用自然资源，包括益生菌、植物或营养保健品。
