Role of bismuth in improving Helicobacter pylori eradication with triple therapy
Role of bismuth in improving Helicobacter pylori eradication with triple therapy
复制标题
铋在三联疗法中促进幽门螺杆菌根除的作用
DOI：
10.1136/gutjnl-2015-311019
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发表时间：
2016-05-01
期刊：
影响因子：
24.5
通讯作者：
Graham, David Y.
中科院分区：
文献类型：
--
作者：
Dore, Maria Pina;Lu, Hong;Graham, David Y.
在世界上大多数地区，抗生素耐药性已经增加到不再推荐经验标准三联疗法根除幽门螺杆菌的程度。人群中的治疗结局计算为易感感染亚群中的治疗成功率加上耐药感染亚群中的治疗成功率之和。尽管抗生素耐药率很高，但添加铋剂（即14天三联疗法加铋剂）可以提高治愈率。铋剂的主要作用是使耐药感染的成功率增加30%-40%。因此，总体结果取决于耐药感染亚群的耐药率和治疗成功率（例如，质子泵转运蛋白-阿莫西林双重治疗）。在这里，我们探讨的贡献，每一个组成部分和机制如何铋可能提高三联疗法的有效性。我们还讨论了这种方法的局限性，并提供建议如何三联疗法加铋剂可能会进一步改善。
In most regions of the world, antimicrobial resistance has increased to the point where empirical standard triple therapy for Helicobacter pylori eradication is no longer recommended. The treatment outcome in a population is calculated as the sum of the treatment success in the subpopulation with susceptible infections plus treatment success in the subpopulation with resistant infections. The addition of bismuth (ie, 14-day triple therapy plus bismuth) can improve cure rates despite a high prevalence of antimicrobial resistance. The major bismuth effect is to add an additional 30%–40% to the success with resistant infections. The overall result is therefore dependent on the prevalence of resistance and the treatment success in the subpopulation with resistant infections (eg, with proton-pump inhibitor–amoxicillin dual therapy). Here, we explore the contribution of each component and the mechanisms of how bismuth might enhance the effectiveness of triple therapy. We also discuss the limitations of this approach and provide suggestions how triple therapy plus bismuth might be further improved.