药敏实验指导及个体化治疗幽门螺杆菌感染的临床探讨

<正>近年来,我国幽门螺杆菌(Hp)的耐药率不断攀升,抗生素耐药菌株的出现已直接影响到Hp根除率,据报道国际标准三联疗法根治率已降至67.2%[1],因此对所分离培养的幽门螺杆菌菌株进行药物敏感试验指导临床治疗意义重大,特别是既往有Hp根除失败的患者,个体化选择性抗生素进行药敏实验,并据结果确定治疗方案,为控制抗菌药物的滥用,降低病原菌耐药水平提供了一条新途径。本文对我院2年来据药敏试验指导根除及传统三联治疗分析,旨在探讨药敏试验对根     

幽门螺杆菌个体化精准根治的研究进展

幽门螺杆菌（Helicobacter pylori,Hp）感染与消化道疾病及全身多个系统的发病相关,其感染率高、致病力强,威胁着人们的身体健康。近年来由于抗生素的滥用,抗生素耐药呈逐年上升趋势,从而导致Hp根除率下降,成为临床棘手的问题。近年来,为了努力提高Hp根除率,国内外学者做了积极探索,提出了“个体化”精准根除治...     

第三次全国幽门螺杆菌感染若干问题共识报告

<正>迄今为止,我国已发布了两次关于幽门螺杆菌(H.pylori)若干问题的共识意见,第一次是1999年4月海南三亚会议提出的《幽门螺杆菌感染若干问题共识意见》——海南共识,该共识于2000年发表:第二次是2003年10月安徽桐城会议提出的《幽门螺杆菌共识意见(2003·安徽桐城)》——桐城共识,于2004年发表。4年多来,我国对H.py- lori处理中的一些重要问题又有了新的认识和见解。     

幽门螺杆菌的合理治疗

自 Warven和 Marshall 1983年发现幽门螺杆菌(helicobacter pylori,Hp)以来 ,有关 Hp与胃肠道疾病之间的关系已得到广泛而深入的研究 ,基于 Hp在消化性溃疡发生、发展及预后方面的重要作用 ,有关 Hp的治疗方案也得到了广泛研究。现就有关 Hp的治疗综述如下。1　 Hp与消化性溃疡有关 Hp感染与消化性溃疡的关系 ,目前已得到了肯定的共识 ,Hp的生物学特性非常适合于胃内环境的生存 ,而Hp在胃内感染常导致胃组织损伤〔1〕。在不使用非甾类抗炎药物或高胃酸分泌状态 (如卓—艾氏综合征等 )时 ,90 %以上十二指肠溃疡和 80 %胃溃疡患者同时感…     

幽门螺杆菌的治疗坝状与进展

幽门螺杆菌(Helicobacter pylori)的发现是消化性溃疡治疗史上的一块里程碑.不仅如此,其还与慢性胃炎、胃黏膜相关淋巴组织淋巴瘤及胃癌密切相关,所以幽门螺杆菌的治疗成为近年消化病学研究的热点.由一种质子泵抑制剂和两种抗感染药物(克拉霉素、阿莫西林或甲硝唑)组成的三联疗法是根治幽门螺杆菌的一线用药.然而,随着克拉霉素和甲硝唑的耐药率越来越高,在耐药比率较高的地区,以铋剂为基础的四联疗法也可作为根治幽门螺杆菌的一线用药选择.当反复根治幽门螺杆菌失败时,推荐以药敏试验为基础指导临床抗感染用药.此外,微生态制剂对根治幽门螺杆菌也有一定作用.     

幽门螺杆菌的治疗坝状与进展

幽门螺杆菌(Helicobacter pylori)的发现是消化性溃疡治疗史上的一块里程碑。不仅如此,其还与慢性胃炎、胃黏膜相关淋巴组织淋巴瘤及胃癌密切相关,所以幽门螺杆菌的治疗成为近年消化病学研究的热点。由一种质子泵抑制剂和两种抗感染药物(克拉霉素、阿莫西林或甲硝唑)组成的三联疗法是根治幽门螺杆菌的一线用药。然而,随着克拉霉素和甲硝唑的耐药率越来越高,在耐药比率较高的地区,以铋剂为基础的四联疗法也可作为根治幽门螺杆菌的一线用药选择。当反复根治幽门螺杆菌失败时,推荐以药敏试验为基础指导临床抗感染用药。此外,微生态制剂对根治幽门螺杆菌也有一定作用。     

根除幽门螺杆菌对幽门狭窄的治疗作用

幽门螺杆菌(HP)根除后十二指肠溃疡并发症如上消化道出血、穿孔和幽门狭窄显著减少^[1]。而HP相关性十二指肠溃疡已并发的幽门狭窄患者，在根除HP后幽门狭窄是否会改善，国外有限资料初步显示了根除HP后幽门狭窄的明显改善^[2]，而国内的类似研究系经内镜气囊扩张后给予根除HP治疗取得良好效果^[3]。我们自1997-06始前瞻性观察了十二指肠溃疡并发幽门狭窄(不完全性梗阻)患者在药物根除HP后幽门狭窄的变化情况。     

幽门螺杆菌感染的药物治疗

<正>幽门螺旋杆菌(HP)感染是消化道溃疡、胃炎、胃癌的重要因素之一,尤其是慢性胃炎患者HP感染率相当高,且耐药性(率)逐年增高[1],HP感染可使IL-1β、L-6过度表达,抑制APE1蛋白的表达,检测胃黏膜中APE1蛋白的表达,从而在参与胃癌的发病中扮演重要角色[2,3],幽门螺杆菌感染发病的机制,治疗的研究从未间断,成为中外学者研究的热门课题。根除HP能加速溃疡愈合,有效地防止溃疡复发,降低胃腺癌发生率,延缓MALT淋巴瘤的发展进程。为此,作者     

糖尿病治疗的总趋势:胰岛素个体化治疗策略

血糖控制水平不佳已是糖尿病控制的棘手难题。多项指南已表明,个体化降糖方案是有效、安全控制血糖的首选策略。基础以及"基础-追加"方案由于符合生理模式,保证了安全、灵活、有效的降糖原则,是目前实现个体化治疗的有效途径。     

临床药师参与1例骨肉瘤超重患儿个体化药物治疗方案的制定

摘 要 目的：探讨临床药师在不规则体重骨肉瘤患儿个体化药物治疗方案制定中发挥的作用。方法: 临床药师参与1例骨肉瘤患儿在化疗期间体质量增长至成人体质量时体表面积的计算,对比分析适用于我国儿童体表面积的计算公式,辅助临床医生制定精确的化疗药物剂量,同时结合该患儿的病理生理特点,在化疗辅助用药预防止吐方案的选择上,为临床提供用药建议。 结果: 医师采纳临床药师建议,患儿顺利完成化疗,避免了根据国外通用体表面积计算公式用于超重儿童,导致药物过量而产生毒性反应,以及为保守治疗而降低治疗量,从而导致药物剂量不足,而产生潜在的抗癌疗效降低的风险。结论:临床药师通过参与特殊人群个体化药物治疗方案的制定,可协助医师制定更加安全、有效的药物治疗方案,减少治疗过程中应用药物出现的不良反应,使儿童肿瘤患者获得最大受益。     

Treatment of Helicobacter pylori

Recognition in the last 12 years that H. pylori is a common infection which causes the majority of peptic ulcers and many gastric cancers has revolutionised understanding of these diseases. However, genuinely novel treatments have in the main not yet emerged. Eradication of H. pylori is difficult because of the problems of delivering bactericidal levels of antibiotics to the gastric mucus where the organism resides, because of the emergence of resistance to nitroimidazoles and clarithromycin, and possibly because H. pylori can assume a resting coccoid form which is not susceptible to antibiotic treatment. To date, eradication treatment has been based upon the use of existing antibiotics employed in intensive multi-drug regimes of three basic types. Bismuth-based triple therapy employed ampicillin or a nitroimidazole, tetracycline and bismuth and achieved eradication rates of approximately 80%. Dual therapy in which amoxycillin was added to omeprazole was briefly popular because of its greater simplicity but fell from favour when it was realised that eradication rates were considerably lower. However, the recognition that proton pump inhibitors enhance eradication by either direct or indirect mechanisms led to the development of what is currently the most effective treatment - proton pump-based triple therapy in which a nitroimidazole or amoxycillin is combined with a proton pump inhibitor and clarithromycin. Such regimes achieve approximately 90% eradication. So far, the only therapy specifically developed for the treatment of H. pylori is ranitidine bismuth citrate (Pylorid). This new chemical entity based on ranitidine and bismuth citrate uses the antibacterial effects of bismuth to kill H. pylori but requires co-administration of another antibiotic to achieve reasonable eradication rates. In the future, further novel, specific anti-Helicobacter treatment can be expected, as a result of strategies targeted at key virulence factors or metabolic pathways such as the organism's urease, adhesin, cytotoxin, oxidase or nitro reductase activities. Some of these strategies will involve vaccination. Other possible approaches include targeting the coccoid form, achieving single treatment eradication and more effective gastric mucus delivery systems.     

基于药物基因组学的选择性5-羟色胺再摄取抑制剂个体化治疗抑郁症

选择性5-羟色胺再摄取抑制剂(SSRIs)是当前治疗抑郁症的一线药物,CYP2D6、CYP2C19基因多态性会影响SSRIs的代谢,进而影响其疗效与安全性.目前我国临床医师对抑郁症患者基于基因多态性的SSRIs个体化治疗实践相对较少.该文就CYP2D6、CYP2C19基因型及其对SSRIs治疗的影响进行综述,以期为抑郁...     

Eradication of Helicobacter pylori: current perspectives

Helicobacter pylori appears to be a necessary cofactor for the majority of non-drug-associated duodenal and gastric ulcers. H. pylori infection is a chronic and transmissible infectious disease whose eradication has proved difficult. The last decade has seen > 1000 clinical trials using different eradication regimens. Many of these trials had severe limitations, some of which will be discussed here. The current review also focuses on the regimens that were used in the past, the present regimens and possibilities for the future. Also highlighted are some other aspects of H. pylori management, such as eradication failures and drug resistance.     

Effective regimens for the treatment of Helicobacter pylori infection

Successful Helicobacter pylori eradication therapy remains a challenge in medical practice. Currently, a proton pump inhibitor-based triple therapy containing clarithromycin, amoxicillin or nitroimidazole for 7 days is the recommended first-line treatment approach with an expected eradication success rate of ～ 80%. As a second-line treatment option in the case of failure, a ranitidine bismuth citrate-based quadruple therapy is currently recommended curing another 80% of patients, leaving a subset of patients with persistent H. pylori infection. For these patients, promising rescue options have been evaluated including regimens that contain rifabutin, quinolones, furazolidone or high-dose amoxicillin. The role of susceptibility testing is still under discussion. It is not generally recommended prior to first-line treatment but guidelines propose a role for culture and antibiotic sensitivity testing after failure of the second attempt. Meanwhile, data on the geographic distribution of resistance pattern are available and may guide therapeutic decisions with regard to the combination of antibiotics chosen for the individual patients aiming at 100% cure rate in each individual patient.     

Correlation of registered drug packs with Maastricht V/Florence Consensus Report and national treatment guidelines for management of Helicobacter pylori infection

High prevalence of Helicobacter pylori infection, the complexity for its treatment, poor correlation of registered drug packs or poor patient adherence to the treatment may contribute to antibiotic resistance and healthcare costs. The aim of the present study was to investigate whether registered drug packs are in accordance with European and national guidelines for H pylori eradication with reference to the number of drug units. In this study, we considered treatment options for the management of H pylori infection recommended by the Maastricht V/Florence Consensus Report and by national guidelines in the United Kingdom (UK), Croatia, Italy and Slovenia for adults. Drugs proposed by the guidelines were identified in national drug databases in July of 2019. When considering correlation for 10‐day treatment regimens, drug packs registered in Croatia could not be matched with recommendations for sequential therapies. A number of proposed treatments could not be matched due to small variety of drug packs in Croatia. Drug packs registered in the UK more often matched recommended 14‐day treatment regimens and national guidelines. With reference to European guidelines, 10‐day treatments could more frequently be matched in Italy and in Slovenia. Furthermore, results of this study indicate that there is smaller variety in drug pack sizes registered in Croatia and Slovenia when compared to UK and Italy. Considering poor correlation of drug packs with treatment guidelines for H pylori, adherence to antimicrobial treatment and proper disposal of antimicrobials is warrant. Discussing adherence to antimicrobial treatment with patients should be introduced as a standard of patient care and education.     

抗幽门螺杆菌药物研究进展

幽门螺杆菌（Helicobacter pylori,HP）感染是胃炎、胃溃疡和胃癌等疾病的主要致病因素之一.近年来,其诱发的胃部疾病发病率呈现上升趋势,抗幽门螺杆菌药物研发已成为热点.本文对抗HP临床现有药物和活性化合物研究现状进行综述.     

Treatment of Helicobacter pylori infection in children

The majority of Helicobacter pylori (H. pylori) infections appear to be acquired during childhood. Despite this fact, the natural history of H. pylori infection in children, such as the mode of acquisition, the clinical symptoms and signs of infection and the appropriate treatment, is poorly understood. There is no consensus regarding which children with H. pylori infection deserve treatment nor is there agreement on the appropriate treatment regimen. This stems from the lack of controlled studies into H. pylori infection during childhood. For example, there have been no controlled studies to determine effective treatment of H. pylori infection in children. Although published guidelines for the treatment of childhood H. pylori infection do not currently exist, there is reasonable evidence to support treatment in children with gastric or duodenal ulcer, gastric MALT (mucosa-associated lymphoid tissue) lymphoma and atrophic gastritis. There is no strong evidence to recommend treatment of children with H. pylori infection and recurrent abdominal pain, asymptomatic infection, children in chronic care facilities and children who have a family member with H. pylori infection. Current evidence suggests that single and dual therapy regimens for H. pylori infection in children are not effective. Triple therapy , generally the combination of 2 antibiotics and a proton pump inhibitor, given two times daily for 2 weeks appears to offer the best current treatment.