Rescue Therapy for Helicobacter pylori Infection 2012.
Rescue Therapy for Helicobacter pylori Infection 2012.
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DOI：
10.1155/2012/974594
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发表时间：
2012
影响因子：
2
通讯作者：
Gisbert JP
中科院分区：
文献类型：
--
作者：
Gisbert JP
幽门螺杆菌感染是引起胃炎、胃十二指肠溃疡和胃癌的主要原因。经过30年的H.幽门螺杆菌的治疗，但理想的方案，以治疗这种感染仍然有待发现。今天，除了要知道良好的第一线根除方案，我们也必须准备面对治疗失败。在设计治疗策略时，我们不仅要关注初级治疗的结果，还要关注最终的总体根除率。“补救”治疗的选择取决于最初使用的治疗。如果使用了基于克拉霉素的一线治疗方案，之后可以使用基于甲硝唑的二线治疗（四联疗法），然后基于左氧氟沙星的联合治疗将是三线“补救”选择。或者，最近有人提出，基于左氧氟沙星的“补救”治疗构成了一种令人鼓舞的二线策略，代表了既往PPI-克拉霉素-阿莫西林治疗失败患者的四联治疗的替代方案，具有疗效、简单性和安全性的优势。在这种情况下，四联方案可作为三线“补救”方案。即使在连续两次失败之后，一些研究已经证明H。如果连续给予几种“补救”疗法，几乎所有患者最终都能根除幽门。
Helicobacter pylori infection is the main cause of gastritis, gastroduodenal ulcer disease, and gastric cancer. After 30 years of experience in H. pylori treatment, however, the ideal regimen to treat this infection has still to be found. Nowadays, apart from having to know well first-line eradication regimens, we must also be prepared to face treatment failures. In designing a treatment strategy, we should not only focus on the results of primary therapy alone but also on the final—overall—eradication rate. The choice of a “rescue” treatment depends on which treatment is used initially. If a first-line clarithromycin-based regimen was used, a second-line metronidazole-based treatment (quadruple therapy) may be used afterwards, and then a levofloxacin-based combination would be a third-line “rescue” option. Alternatively, it has recently been suggested that levofloxacin-based “rescue” therapy constitutes an encouraging 2nd-line strategy, representing an alternative to quadruple therapy in patients with previous PPI-clarithromycin-amoxicillin failure, with the advantage of efficacy, simplicity and safety. In this case, quadruple regimen may be reserved as a 3rd-line “rescue” option. Even after two consecutive failures, several studies have demonstrated that H. pylori eradication can finally be achieved in almost all patients if several “rescue” therapies are consecutively given.
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