优化治疗:基于经验和药敏试验的治疗方法的最新综述。

Optimizing Treatment: An Updated Review of Empirical and Susceptibility Test-Based Treatments.

机构信息

Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan.

出版信息

Gut Liver. 2023 Sep 15;17(5):684-697. doi: 10.5009/gnl220429. Epub 2023 Feb 27.

Abstract

As the rate of discovery of drug-resistant cases increases worldwide, the relevant societies have updated their guidelines for primary eradication regimens. A promising strategy against drug-resistant is tailored therapy based on the results of an antibiotic susceptibility test; however, it is difficult to apply this strategy to all cases. Although culture-based antibiotic susceptibility tests can assess resistance to any antimicrobial agent, their greatest disadvantage is the time required to draw a conclusion. In contrast, molecular-based methods, such as polymerase chain reaction, can rapidly determine the presence of resistance, although a single test can only test for one type of antimicrobial agent. Additionally, the limited availability of facilities for molecular-based methods has hindered their widespread use. Therefore, low-cost, minimally invasive, simple, and effective primary regimens are needed. Several studies have compared the efficacy of the latest primary eradication regimens against that of tailored therapies, and their results have shaped guidelines. This article reviews the latest research on empirical and tailored treatments for infections. Evidence for the superiority of tailored therapy over empirical therapy is still limited and varies by region and treatment regimen. A network meta-analysis comparing different empirical treatment regimens showed that vonoprazan triple therapy provides a superior eradication effect. Recently, favorable results towards vonoprazan dual therapy have been reported, as it reached eradication levels similar to those of vonoprazan triple therapy. Both vonoprazan dual therapy and tailored therapy based on antibiotic susceptibility tests could contribute to future treatment strategies.

摘要

随着全球耐药病例发现率的增加,相关社会已更新其主要根除方案的指南。针对耐药的一种有前途的策略是根据抗生素药敏试验结果进行靶向治疗;然而,很难将这种策略应用于所有病例。虽然基于培养的抗生素药敏试验可以评估对任何抗菌药物的耐药性,但它们最大的缺点是得出结论所需的时间。相比之下,基于分子的方法,如聚合酶链反应,可以快速确定耐药性的存在,尽管单次测试只能测试一种类型的抗菌药物。此外,分子方法的设施有限,阻碍了其广泛应用。因此,需要低成本、微创、简单和有效的主要方案。一些研究比较了最新的主要根除方案与靶向治疗的疗效,其结果为指南的制定提供了依据。本文综述了最新的关于 感染经验性和靶向治疗的研究。靶向治疗优于经验性治疗的证据仍然有限,且因地区和治疗方案而异。一项比较不同经验性治疗方案的网络荟萃分析显示,沃诺拉赞三联疗法具有更好的根除效果。最近,沃诺拉赞双联疗法也取得了良好的效果,因为它达到了与沃诺拉赞三联疗法相似的根除水平。沃诺拉赞双联疗法和基于抗生素药敏试验的靶向治疗都可能为未来的治疗策略做出贡献。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/71be/10502504/89fa0bd8d5e5/gnl-17-5-684-f1.jpg

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