幽门螺杆菌根除方法新进展

幽门螺杆菌(Helicobacter pylori,HP)感染是慢性胃炎、消化性溃疡及胃癌的主要致病原因,根除HP感染可以有效降低胃癌发病率.推荐一线根除方案为PPI或雷尼替丁枸椽酸铋+克拉霉素、甲硝唑及阿莫西林中的两种抗生素,疗程7～14天,但其根除失败率高达20％.二线治疗方案包括标准四联方案(铋剂+四环素+甲硝唑+PPI)或三联方案(PPI+左氧氟沙星+阿莫西林).对于二线治疗失败的病人,应采取个体化治疗措施,根据药敏结果选用药物,或使用新的抗生素.可供选择的三线治疗药物有喹喏酮类药物、四环素、利福布汀以及呋喃唑酮等,大剂量PPI+阿莫西林也显示出了良好疗效.

Recent advances in Helicobacter Pylori eradication

Helicobacter（H.） pylori infection is the main cause of gastritis,gastroduodenal ulcers and gastric cancer.H.pylori eradication has been shown to have a prophylactic effect against gastric cancer. According to several international guidelines,the first-line therapy for treating H.pylori infection consists of a proton pump inhibitor （PPI）or ranitidine bismuth citrate,with any two antibiotics among amoxicillin,clarithromycin and metronidazole,given for 7 14 d. However,even with these recommended regimens,H.pylori eradication failure is still seen in more than 20% of patients.The failure rate for first-line therapy may be higher in actual clinical practice, owing to the indiscriminate use of antibiotics.The recommended second-line therapy is a quadruple regimen composed of tetracycline, metronida- zole,a bismuth salt and a PPI. The combination of PPI amoxieillin - levofloxacin is a good option as second-line therapy. In the case of failure of second-line therapy,the patients should be evaluated using a case-by-case approach.European guidelines recommend culture before the selection of a third-line treatment based on the microbial antibiotic sensitivity. H. pylori isolates after two eradication failures are often resistant to both metronidazole and clarithromycin. The alternative candidates for third-line therapy are quinolones,tetracycline, rifabutin and furazolidone; high-dose PPI/amoxicillin therapy might also be promising.