Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 1018309, Japan.
World J Gastroenterol. 2019 Apr 28;25(16):1907-1912. doi: 10.3748/wjg.v25.i16.1907.
() antimicrobial resistance is an urgent, global issue. In 2017, the World Health Organization designated clarithromycin-resistant as a high priority bacterium for antibiotic research and development. In addition to clarithromycin, resistance to metronidazole and fluoroquinolones has also increased worldwide. Recent international guidelines for management of infection recommend bismuth or non-bismuth quadruple therapy for 14 d as a first-line treatment for in areas of high clarithromycin and/or metronidazole resistance. Although these treatment regimens provide acceptable eradication rates, the regimens used should not contribute to future resistance of to antimicrobials. Moreover, these regimens can promote resistance, due to prolonged therapy with multiple antibiotics. A new strategy that can eradicate as well as reduce the antibiotics used is required to prevent future antimicrobial resistance in . Dual-therapy with vonoprazan and amoxicillin could be a breakthrough for eradication in an era of growing antimicrobial resistance. This regimen may provide a satisfactory eradication rate of and also minimize antimicrobial resistance due to single antibiotic use and the strong inhibitory effect of vonoprazan on gastric acid secretion.
（幽门螺杆菌）抗菌药物耐药性是一个紧迫的全球性问题。2017 年，世界卫生组织将克拉霉素耐药的幽门螺杆菌指定为抗生素研发的重点细菌。除克拉霉素外，全球范围内甲硝唑和氟喹诺酮类药物的耐药性也有所增加。最近针对幽门螺杆菌感染的国际管理指南建议，对于克拉霉素和/或甲硝唑耐药率高的地区，使用铋剂或非铋剂四联疗法治疗 14 天作为一线治疗方案。虽然这些治疗方案提供了可接受的根除率，但使用的方案不应导致幽门螺杆菌对其他抗生素的未来耐药性。此外，由于长期使用多种抗生素，这些方案可能会促进耐药性的产生。为了防止未来的抗菌药物耐药性，需要一种既能根除幽门螺杆菌又能减少抗生素使用的新策略。沃诺拉赞和阿莫西林的双联疗法可能是在抗菌药物耐药性日益严重的时代根除幽门螺杆菌的一个突破。这种方案可能提供令人满意的根除率，同时由于单一抗生素的使用和沃诺拉赞对胃酸分泌的强烈抑制作用，最大限度地减少抗菌药物耐药性。
