Graham D Y
Department of Medicine, Veterans Affairs Medical Center, Houston, TX 77030, USA.
Eur J Gastroenterol Hepatol. 1995 Aug;7 Suppl 1:S55-8.
A better appreciation of the causal relationship between Helicobacter pylori infection and peptic ulcer disease and the benefit conferred by curing this infection has led to the recommendation that all patients with duodenal ulcer disease receive anti-H. pylori treatment. Multi-drug regimens, including bismuth, metronidazole and tetracycline or amoxycillin with an antisecretory agent, are successful in > 90% of treated patients but the emergence of metronidazole-resistant H. pylori has begun to limit their effectiveness.
The search for the optimal anti-H. pylori treatment has focused on simplifying the regimen (to decrease adverse drug-related events and increase patient compliance), while retaining the excellent clinical results of the traditional multi-drug regimens. This article reviews the data concerning clarithromycin for treatment of H. pylori infections.
Numerous evaluations have shown that clarithromycin has desirable attributes for anti-H. pylori treatment: clarithromycin is resistant to gastric acid, penetrates in high concentrations into gastric tissue and mucus, shows excellent antimicrobial activity against H. pylori, results in a high cure rate when used in two- and three-drug combinations, is associated with a low incidence of acquired H. pylori resistance and is well tolerated. Successful clarithromycin therapies include clarithromycin+omeprazole, clarithromycin+amoxycillin, or clarithromycin+omeprazole+tinidazole or metronidazole, and clarithromycin triple therapy.
Clarithromycin may become an integral component of anti-H. pylori therapy.
对幽门螺杆菌感染与消化性溃疡病之间因果关系以及根除该感染所带来益处的更深入认识，促使人们建议所有十二指肠溃疡病患者接受抗幽门螺杆菌治疗。包括铋剂、甲硝唑和四环素或阿莫西林与一种抑酸剂的多药联合方案，在超过90%的接受治疗患者中取得成功，但甲硝唑耐药幽门螺杆菌的出现已开始限制其有效性。
寻找最佳抗幽门螺杆菌治疗方法的研究重点在于简化治疗方案（以减少药物相关不良事件并提高患者依从性），同时保留传统多药联合方案出色的临床疗效。本文综述了有关克拉霉素治疗幽门螺杆菌感染的数据。
大量评估表明，克拉霉素具有抗幽门螺杆菌治疗所需的特性：克拉霉素对胃酸有抗性，能高浓度渗透到胃组织和黏液中，对幽门螺杆菌显示出出色的抗菌活性，在二联和三联用药组合中使用时治愈率高，与获得性幽门螺杆菌耐药发生率低相关且耐受性良好。成功的克拉霉素治疗方案包括克拉霉素+奥美拉唑、克拉霉素+阿莫西林，或克拉霉素+奥美拉唑+替硝唑或甲硝唑，以及克拉霉素三联疗法。
克拉霉素可能成为抗幽门螺杆菌治疗的一个重要组成部分。
