Treatment of Helicobacter pylori infection: Current status and future concepts
Treatment of Helicobacter pylori infection: Current status and future concepts
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DOI：
10.3748/wjg.v20.i18.5283
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发表时间：
2014-05-14
影响因子：
4.3
通讯作者：
Lin, Chun-Jung
中科院分区：
文献类型：
--
作者：
Yang, Jyh-Chin;Lu, Chien-Wei;Lin, Chun-Jung
幽门螺杆菌(Hp)感染与胃炎、消化性溃疡、胃癌、胃粘膜相关淋巴组织淋巴瘤等胃肠道疾病的发生密切相关。尽管已经使用了包括植物药物和益生菌在内的替代疗法来改善根除，但目前的治疗仍然依赖于抗菌剂(如阿莫西林、克拉霉素、甲硝唑和左氧氟沙星)和抗分泌剂(如质子泵抑制剂)的组合。由PPI和两种抗生素(克拉霉素和阿莫西林/甲硝唑)组成的标准三联疗法被广泛用作感染治疗的一线方案，但幽门螺杆菌对克拉霉素和甲硝唑的耐药性增加显著降低了这种疗法的根治率，因此建议用含铋疗法或10天序贯疗法来取代标准的三联疗法。在一线治疗失败后，左氧氟沙星为基础的三联疗法也可作为幽门螺杆菌感染的抢救治疗。对包括左氧氟沙星在内的抗生素耐药性的增加可能会限制此类方案的适用性。然而，由于幽门螺杆菌对阿莫西林的耐药性普遍较低，由PPI和阿莫西林组成的优化大剂量双重疗法可能是一种有效的一线或抢救疗法。此外，替代药物的联合使用有可能提供对抗幽门螺杆菌感染的相加或协同作用，尽管其有效性还需要在临床研究中得到验证。(C)2014年白石登出版集团有限公司。版权所有。幽门螺杆菌
Helicobacter pylori (H. pylori) infection is highly associated with the occurrence of gastrointestinal diseases, including gastric inflammation, peptic ulcer, gastric cancer, and gastric mucosa-associated lymphoid-tissue lymphoma. Although alternative therapies, including phytomedicines and probiotics, have been used to improve eradication, current treatment still relies on a combination of antimicrobial agents, such as amoxicillin, clarithromycin, metronidazole, and levofloxacin, and antisecretory agents, such as proton pump inhibitors (PPIs). A standard triple therapy consisting of a PPI and two antibiotics (clarithromycin and amoxicillin/metronidazole) is widely used as the first-line regimen for treatment of infection, but the increased resistance of H. pylori to clarithromycin and metronidazole has significantly reduced the eradication rate using this therapy and bismuth-containing therapy or 10-d sequential therapy has therefore been proposed to replace standard triple therapy. Alternatively, levofloxacin-based triple therapy can be used as rescue therapy for H. pylori infection after failure of first-line therapy. The increase in resistance to antibiotics, including levofloxacin, may limit the applicability of such regimens. However, since pylori resistance of H. pylori to amoxicillin is generally low, an optimized high dose dual therapy consisting of a PPI and amoxicillin can be an effective first-line or rescue therapy. In addition, the concomitant use of alternative medicine has the potential to provide additive or synergistic effects against H. pylori infection, though its efficacy needs to be verified in clinical studies. (C) 2014 Baishideng Publishing Group Co., Limited. All rights reserved. pylori