Borody T J, Shortis N P, Reyes E
Centre for Digestive Diseases, Five Dock, NSW, Australia.
J Gastroenterol. 1998;33 Suppl 10:53-6.
Eradication therapies for Helicobacter pylori evolved from monotherapy, through dual therapies and finally to bismuth-based triple therapies by the mid-1980s. The advent of proton pump inhibitors (PPI) and clarithromycin added a new impetus in the development of newer and often more effective regimens. Following large numbers of therapeutic trials, two broad groups of therapies stand out which consistently achieve over 90% eradication. Both are PPI-based. PPI/amoxycillin/clarithromycin twice daily therapy is the simplest but perhaps the most expensive. The 7-day quadruple (quad) therapy, consisting of a PPI and bismuth/tetracycline/metronidazole, is rapidly emerging as the "all rounder" therapy able not only to overcome metronidazole and clarithromycin resistance but to also have a consistently high eradication rate of well over 90%. Extensive clinical use of older and cut-down versions of combination therapies is resulting in a rising population of treated patients who continue to be infected with H. pylori, often resistant to further eradication attempts. Failure to recognise the need to use regimens which achieve high first-time eradication success will lead inexorably to an enlarging pool of patients with resistant strains and "difficult-to-eradicate" H. pylori.
幽门螺杆菌的根除疗法从单一疗法发展而来，历经联合疗法，最终在20世纪80年代中期演变为以铋剂为基础的三联疗法。质子泵抑制剂（PPI）和克拉霉素的出现为更新且通常更有效的治疗方案的开发注入了新动力。经过大量治疗试验，有两类疗法脱颖而出，其根除率始终超过90%。这两类疗法均以PPI为基础。PPI/阿莫西林/克拉霉素每日两次疗法最为简单，但可能也是最昂贵的。由PPI与铋剂/四环素/甲硝唑组成的7天四联疗法正迅速成为“全能”疗法，不仅能够克服甲硝唑和克拉霉素耐药性，而且根除率始终高达90%以上。旧的联合疗法及其简化版本的广泛临床应用导致接受治疗但仍感染幽门螺杆菌的患者数量不断增加，这些患者往往对进一步的根除尝试产生耐药性。如果未能认识到需要采用首次根除成功率高的治疗方案，将不可避免地导致耐药菌株患者群体和“难以根除”的幽门螺杆菌患者群体不断扩大。
