Department of Gastroenterology & Clinical Medicine, Tallaght University Hospital, Trinity College Dublin, Dublin, Ireland.
Department of Medical, Surgical and Experimental Science, University of Sassari, Sassari, Italy.
Helicobacter. 2018 Sep;23 Suppl 1:e12519. doi: 10.1111/hel.12519.
Treatment options for the eradication of Helicobacter pylori continue to evolve. There have been many guidelines for H. pylori treatment published, which may lead to some confusion. However, most are in agreement with the most recent iteration of the Maastricht treatment guidelines. Triple therapy is still the most frequently used treatment, especially in areas of low clarithromycin resistance. Its best results are achieved when taken for a minimum of 10 days and with high-dose acid suppression. Quadruple therapy is gaining in popularity particularly in areas with increasing resistance to standard triple therapy. Whether three antibiotics, or bismuth and two antibiotics are used, excellent eradication rates are achieved, albeit with increased side effects. Levofloxacin second-line therapy is widely used; however bismuth, when available, is an increasingly successful option. Sequential therapy is challenging in terms of compliance and is no longer recommended. This past year witnessed a notable increase in the number of studies based on antimicrobial susceptibility testing and tailored eradication therapy, reflecting the role of culture-guided treatment, which may well represent the future of H. pylori treatment and prevent the inappropriate use of antibiotics.
幽门螺杆菌的根除治疗方案不断发展。已经发布了许多幽门螺杆菌治疗指南，这可能会导致一些混淆。然而，大多数指南与最近的马斯特里赫特治疗指南一致。三联疗法仍然是最常用的治疗方法，尤其是在克拉霉素耐药率较低的地区。当三联疗法至少使用 10 天并进行高剂量酸抑制时，其效果最佳。四联疗法在耐药率不断上升的地区越来越受欢迎。无论是使用三种抗生素还是铋剂和两种抗生素，都能达到很高的根除率，尽管副作用增加。左氧氟沙星二线治疗广泛应用；然而，在有条件的情况下，铋剂是一种越来越成功的选择。序贯疗法在依从性方面具有挑战性，因此不再推荐。过去一年，基于抗生素药敏试验和针对性根除治疗的研究显著增加，反映了基于培养的治疗方法的作用，这可能代表着幽门螺杆菌治疗的未来，并防止抗生素的不当使用。
