- 期刊
幽門螺旋桿菌感染治療的最新進展
Recent advances in treatment of H. pylori infection
摘要
幽門螺旋桿菌感染是引起胃癌產生的主因，許多研究顯示；根除幽門螺旋桿菌可以明顯減少胃癌的發生。若除菌治療能於幽門螺旋桿菌相關性癌前病變產生前執行，更能有效預防胃癌。近年來，隨著全球抗藥菌株的增加，醫師常用之標準三合一療法對幽門螺旋桿菌的除菌率在各國有下降之趨勢，因此有許多新的除菌療法被發展出來。本文針對現今幽門螺旋桿菌除菌治療的新進展，作一整理。在clarithromycin抗藥率高的地區（如台灣），7天或14天之標準三合一療法已無法達到超過90%的除菌率，建議使用10-14天共伴療法、14天混合療法、14天反轉式混合療法、14天系列療法或10-14天含鉍劑四合一療法來治療幽門螺旋桿菌感染，這些第一線療法的除菌率均可達到或超過90%。此外，含vonoprazan之單一抗生素療法（vonoprazan-tetracycline二合療法、vonoprazan-amoxicillin二合療法、vonoprazan-amoxicillin-bismuth三合療法）及vonoprazan-amoxicillin-clarithromycin三合療法亦有優異之除菌效果，近年來受到相當大的重視，極有可能未來會翻轉整個幽門螺旋桿菌之治療。當幽門螺旋桿菌第一線治療失敗時，可選用第二線療法，包括鉍劑四合一療法、以levofloxacin為基礎的療法，包括levofloxacin-amoxicillin三合療法、levofloxacin-amoxicillin四合療法、tetracycline-levofloxacin四合療法、高劑量二合療法或抗藥性引導治療。當第二線治療再次失敗時，建議進行幽門螺旋桿菌培養和敏感性測試或進行抗藥性基因型分子測定，而後依細菌抗藥性，進行除菌治療。
並列摘要
Helicobacter pylori (H. pylori) infection is the main cause of gastric cancer. Many studies have shown that eradicating H. pylori can significantly reduce the occurrence of gastric cancer. If eradication treatment can be performed before the occurrence of H. pylori-related precancerous lesions, it will be more effective in preventing gastric cancer. In recent years, with the increase in drug-resistant strains around the world, the eradication rate of H. pylori, which is the standard triple therapy commonly used by doctors, has been declining in various countries. Therefore, many new anti-H. pylori regimens have been developed. This article summarizes the current new developments in the eradication treatment of H. pylori. In areas with high clarithromycin resistance rates (such as Taiwan), the standard triple therapy of 7 days or 14 days can no longer achieve a bactericidal rate of more than 90%. It is recommended to use 10~14-day concomitant therapy, 14-day hybrid therapy, 14-day reverse hybrid therapy, 14-day sequential therapy, or 10~14-day bismuth-containing quadruple therapy to treat H. pylori infection. The bactericidal rate of these first-line therapies can reach or exceed 90%. In addition, single antibiotic therapy containing vonoprazan (vonoprazan-tetracycline dual therapy, vonoprazan-amoxicillin dual therapy, vonoprazan-amoxicillin-bismuth triple therapy) and vonoprazan-amoxicillin-clarithromycin triple therapy also have excellent bactericidal effects. In recent years, it has received considerable attention and is very likely to revolutionize the entire treatment of H. pylori in the future. When the first-line treatment for H. pylori fails, second-line therapy can be used, including bismuth quadruple therapy, levofloxacin-based therapy, including levofloxacin-amoxicillin triple therapy, levofloxacin-amoxicillin quadruple therapy, tetracycline-levofloxacin quadruple therapy, high-dose dual therapy, or resistance-guided therapy. When the second-line treatment fails again, it is recommended to perform H. pylori culture and sensitivity testing or molecular determination of drug resistance genotypes, and then perform antibacterial treatment according to bacterial drug resistance.