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S3-2
幽門螺旋桿菌除菌治療：過去、現在與未來
Anti-H pylori therapy : past, present and future
Ping-I Hsu
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and National Yang-Ming University, Kaohsiung, Taiwan |
With the rising prevalence of antimicrobial resistance, the eradication rate of standard triple therapy has recently declined to unacceptable levels, and anti-H pylori treatment is continuing to be a great challenge for physicians in clinical practice. The Real-world Practice & Expectation of Asia-Pacific Physicians and Patients in Helicobacter Pylori Eradication (REAP-HP) Survey demonstrated that the accepted minimal eradication rate of anti-H pylori regimen in H pylori-infectedpatients was 91%. The Kyoto Consensus Report on Helicobacter Pylori Gastritis also recommended that, within any region, only regimens which reliably produce eradication rates of ≥ 90% in that population should be used for empirical treatment.
In regions with low (＜ 10%) clarithromycin resistance, 14-day hybrid (or reverse hybrid), 10∼14-day sequential, 7∼14-day concomitant, 10∼14-day bismuth quadruple or 14-day triple therapy can achieve a high eradication rate in the first-line treatment of H pylori infection. However, in areas with high (≧10%) clarithromycin resistance, standard triple therapy should be abandon because of low eradication efficacy, and 14-day hybrid (or reverse hybrid), 7∼14-day concomitant or 10∼14-day bismuth quadruple therapy are the recommended regimens. If no recent data of local antibiotic resistances of H. pylori strains are available, universal high efficacy regimens such as 14-day hybrid (or reverse hybrid), 7∼14-day concomitant or 10∼14-day bismuth quadruple therapy can be adopted to meet the recommendation of consensus report and patients’ expectation.
Current updated second-line therapies include bismuth quadruple therapy, fluoroquinolone-amoxicillin triple therapy, fluoroquinolone-amoxicillin quadruple therapy, tetracycline-levofloxacin (TL) quadruple therapy and high-dose dual therapy. Ten-day TL quadruple therapy has a great potential to become a universal rescue treatment following eradication failure by all first-line eradication regimens for H pylori infection.
Most guidelines suggest that patients requiring third-line therapy should be referred to medical center and treated according to the antibiotic susceptibility test. Nonetheless, an empirical therapy (such as levofloxacin-containing, rifabutin- containing, or furazolidone-containing therapies) can be employed to terminate H pylori infection if antimicrobial sensitivity data are unavailable. |
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