Walsh J H, Peterson W L
Center for Ulcer Research and Education, Veterans Affairs/UCLA Gastroenteric Biology Center, USA.
N Engl J Med. 1995 Oct 12;333(15):984-91. doi: 10.1056/NEJM199510123331508.
Antimicrobial therapy against H. pylori is indicated for all patients with documented peptic ulcer disease who have evidence of the infection. The regimen of first choice, selected on the basis of available studies, is triple therapy with bismuth, metronidazole, and tetracycline (Table 1). For patients who are known to have taken metronidazole previously, clarithromycin may be substituted for metronidazole. For patients with active, symptomatic peptic ulcers we also recommend an antisecretory drug to promote healing and relieve symptoms. Second-choice regimens consist of combinations of two antimicrobial drugs--metronidazole, amoxicillin, or clarithromycin--with an antisecretory agent, preferably an H+/K+-ATPase antagonist such as omeprazole. The combination of a single antimicrobial drug (especially amoxicillin) with omeprazole is less efficacious and cannot be recommended. Regardless of the antimicrobial regimen used, successful eradication of H. pylori infection markedly reduces the risk of recurrent peptic ulcers. If this therapeutic approach is taken with all patients with peptic ulcers, the recurrence of ulcers should become a rarity in medical practice.
对于所有确诊为消化性溃疡且有幽门螺杆菌感染证据的患者，均应进行抗幽门螺杆菌治疗。根据现有研究，首选治疗方案是铋剂、甲硝唑和四环素三联疗法（表1）。对于已知先前使用过甲硝唑的患者，可用克拉霉素替代甲硝唑。对于有活动性、有症状的消化性溃疡患者，我们还建议使用一种抗分泌药物以促进愈合并缓解症状。二线治疗方案包括两种抗菌药物（甲硝唑、阿莫西林或克拉霉素）与一种抗分泌剂联合使用，抗分泌剂最好选用H+/K+-ATP酶拮抗剂，如奥美拉唑。单一抗菌药物（尤其是阿莫西林）与奥美拉唑联合使用疗效较差，不推荐使用。无论采用何种抗菌治疗方案，成功根除幽门螺杆菌感染可显著降低消化性溃疡复发的风险。如果对所有消化性溃疡患者都采用这种治疗方法，溃疡复发在医疗实践中应会变得罕见。
