Strategy for the treatment of Helicobacter pylori infection.
Strategy for the treatment of Helicobacter pylori infection.
复制标题
DOI：
10.2174/13816128113196660731
复制
发表时间：
2014-07
影响因子：
3.1
通讯作者：
S. Shiota;Y. Yamaoka
中科院分区：
文献类型：
--
作者：
S. Shiota;Y. Yamaoka
根除幽门螺杆菌不仅可以治愈消化性溃疡，还可以防止其复发，并降低患胃癌和其他幽门螺杆菌相关疾病的风险。根除幽门螺杆菌可以治愈胃炎，并可以防止感染传播，从而减少未来治疗后续幽门螺杆菌相关疾病所需的费用。世界范围内有各种针对幽门螺杆菌感染管理的指南，例如美国胃肠病学会、马斯特里赫特第四届会议、第二届亚太共识会议和日本的指南。日本健康保险系统于2013年批准了针对幽门螺杆菌相关慢性胃炎的幽门螺杆菌根除疗法。包括1种质子泵抑制剂和2种抗菌药物（如阿莫西林、克拉霉素、甲硝唑、左氧氟沙星或四环素）的三联疗法已被广泛用于根除这种细菌。由于抗生素的广泛使用导致耐药率增加，成功根除率有所下降。这个问题与克拉霉素尤其相关。在世界范围内，基于克拉霉素的三联疗法应该被放弃，因为它不再有效。四联疗法和序贯疗法是初始治疗的合理选择。应在了解当地幽门螺杆菌耐药性流行情况的基础上推荐一线治疗。
The eradication of Helicobacter pylori not only heals peptic ulcers but also prevents their recurrence and reduces the risk of development of gastric cancer and other H. pylori-associated disorders. H. pylori eradication heals gastritis and may prevent the spread of infection, reducing the future costs required for the treatment of subsequent H. pylori-associated diseases. There are various guidelines for the management of H. pylori infection worldwide, such as the guidelines of the American College of Gastroenterology, Maastricht IV, the Second Asia-Pacific Consensus Conference, and Japan. The Japanese health insurance system approved H. pylori eradication therapy for H. pylori-related chronic gastritis in 2013. Triple therapy regimens comprising 1 proton pump inhibitor and 2 antimicrobial agents such as amoxicillin, clarithromycin, metronidazole, levofloxacin, or tetracycline have been widely used to eradicate this bacterium. The rate of successful eradication has declined owing to the increased rate of drug resistance stemming from the wide usage of antibiotics. This issue is of particular relevance with regard to clarithromycin. In worldwide, clarithromycin-based triple therapy should be abandoned, as it is no longer effective. Quadruple therapy and sequential therapy are reasonable alternatives for initial therapy. First-line treatment should be recommended on the basis of an understanding of the local prevalence of H. pylori antimicrobial resistance.