Importance of antimicrobial susceptibility testing for the management of eradication in Helicobacter pylori infection.
Importance of antimicrobial susceptibility testing for the management of eradication in Helicobacter pylori infection.
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DOI：
10.3748/wjg.v23.i16.2854
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发表时间：
2017-04-28
影响因子：
4.3
通讯作者：
Demiray-Gürbüz E
中科院分区：
文献类型：
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作者：
Arslan N;Yılmaz Ö;Demiray-Gürbüz E
幽门螺杆菌（Helicobacter pylori，H.幽门螺杆菌）感染的治疗不同于其他传染病的常见治疗方案。由于培养或分子引导的方法面临着几个实际问题，如获得胃活检标本所需的侵入性程序和在某些地方缺乏常规实验室检测，H。幽门螺杆菌治疗包括施用两种或三种经验选择的抗生素与质子泵抑制剂的组合，而不是基于证据的根除治疗。经验疗法的疗效正在下降，主要是由于多重耐药增加。在许多国家，对经验性治疗中常用的左氧氟沙星、克拉霉素和甲硝唑的多重耐药似乎有所增加。突变在H.幽门螺杆菌，但许多不同的机制可以参与抗生素耐药性的发展。确定和理解这些可能的机制可能有助于开发新的方法来检测H。幽门螺杆菌和抗菌药物耐药性的测定。基于抗生素耐药性检测的治疗通常比经验性治疗更有效。尽管如此，马斯特里赫特指南仍然不推荐在治疗前采用这种方法，因为常规应用基于培养或分子的敏感性试验存在困难，这些试验通常在治疗失败的情况下进行。由于抗菌素耐药性的稳步增加，首次和补救治疗的管理需要进一步研究。
The management of Helicobacter pylori (H. pylori) infection treatment differs from the common treatment protocol for other infectious diseases. Because culture- or molecular-guided approaches face several practical issues, such as the invasive procedures required to obtain gastric biopsy specimens and the lack of availability of routine laboratory testing in some places, H. pylori treatment includes the administration of two or three empirically selected antibiotics combined with a proton pump inhibitor rather than evidence-based eradication treatment. The efficacy of empirical therapy is decreasing, mostly due to increasing multiple resistance. Multiresistance to levofloxacin, clarithromycin, and metronidazole, which are commonly used in empirical treatments, appears to have increased in many countries. Mutations play a primary role in the antimicrobial resistance of H. pylori, but many different mechanisms can be involved in the development of antibiotic resistance. Determining and understanding these possible mechanisms might allow the development of new methods for the detection of H. pylori and the determination of antimicrobial resistance. A treatment based on the detection of antimicrobial resistance is usually more effective than empirical treatment. Nevertheless, such an approach before treatment is still not recommended in the Maastricht guidelines due to the difficulty associated with the routine application of available culture- or molecular-based susceptibility tests, which are usually administered in cases of treatment failure. The management of first and rescue treatments requires further research due to the steadily increase in antimicrobial resistance.