Rational Helicobacter pylori Therapy: Evidence-Based Medicine Rather Than Medicine-Based Evidence
Rational Helicobacter pylori Therapy: Evidence-Based Medicine Rather Than Medicine-Based Evidence
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DOI：
10.1016/j.cgh.2013.05.028
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发表时间：
2014-02-01
影响因子：
12.6
通讯作者：
Wu, Ming-Shiang
中科院分区：
文献类型：
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作者：
Graham, David Y.;Lee, Yi-Chia;Wu, Ming-Shiang
数据是可用的，因此可以可靠地预测个体患者的幽门螺杆菌治疗选择。在这里，治疗成功被定义为90%或更高的治愈率。可以根据治疗方案对敏感菌株和耐药菌株感染的有效性以及耐药流行率的知识（即，基于正式测量、临床经验或两者）计算人群或患者的治疗结局。我们提供了预测结果的公式，并说明了计算方法。由于含克拉霉素的三联疗法和10天序贯疗法目前仅在特殊人群中有效，因此认为它们已过时;两者均不应继续用作经验性疗法（即，当克拉霉素耐药性分别超过5%和15%时，7天和14天三联疗法失败，当甲硝唑耐药性超过20%时，10天序贯疗法失败）。治疗应根据既往病史以及患者是否属于耐药高危人群进行个体化。西方国家的首选方案是14天伴随治疗、14天铋剂四联治疗和14天混合序贯伴随治疗。我们还提供了有关氟喹诺酮类药物、利福昔单抗和呋喃唑酮治疗的成功使用的详细信息。最后，我们提供了新方案的有效开发（即识别和优化），以及如何防止或尽量减少失败的建议。确定和测试方案的试错法经常导致治疗成功率不高。所描述的方法可以预测结果，并应简化治疗和药物开发。
Data are available such that choice of Helicobacter pylori therapy for an individual patient can be reliably predicted. Here, treatment success is defined as a cure rate of 90% or greater. Treatment outcome in a population or a patient can be calculated based on the effectiveness of a regimen for infections with susceptible and with resistant strains coupled with the knowledge of the prevalence of resistance (ie, based on formal measurement, clinical experience, or both). We provide the formula for predicting outcome and we illustrate the calculations. Because clarithromycin-containing triple therapy and 10-day sequential therapy are now only effective in special populations, they are considered obsolete; neither should continue to be used as empiric therapies (ie, 7- and 14-day triple therapies fail when clarithromycin resistance exceeds 5% and 15%, respectively, and 10-day sequential therapy fails when metronidazole resistance exceeds 20%). Therapy should be individualized based on prior history and whether the patient is in a high-risk group for resistance. The preferred choices for Western countries are 14-day concomitant therapy, 14-day bismuth quadruple therapy, and 14-day hybrid sequential-concomitant therapy. We also provide details regarding the successful use of fluoroquinolone-, rifabutin-, and furazolidone-containing therapies. Finally, we provide recommendations for the efficient development (ie, identification and optimization) of new regimens, as well as how to prevent or minimize failures. The trial-and- error approach for identifying and testing regimens frequently resulted in poor treatment success. The described approach allows outcome to be predicted and should simplify treatment and drug development.