幽門螺旋桿菌除菌治療之新進展

近年來，隨著抗藥菌株的增加，原本之標準治療方法對幽門螺旋桿菌的除菌率在全球有下降之趨勢，因此有許多新的療法被發展出來。本文特別針對現今幽門螺旋桿菌之除菌治療的新進展，作一概述。目前，大部份之國際性治療準則所建議之幽門螺旋桿菌第一線除菌治療方法仍爲由質子幫浦阻斷劑、Clarithromycin和Amoxicillin（或Metronidazole）所組成之標準三合療法。此一治療方法的失敗率在全球許多地區已高達20%以上。「系列性治療」是新近被發展出的另一種第一線除菌療法，其除菌率達94%。此外，由質子幫浦阻斷劑、Amoxicillin、Clarithromycin和Metronidazole所組成的7天四合治療也具有優異的療效。在第二線治療上，目前推薦的標準治療是由質子幫浦阻斷劑、鉍劑、Tetracycline和Metronidazole所組成之四合療法，此一治療方法在全球之除菌率不一，從37%到95%。近年來，有學者以10天之以Levofloxacin、Amoxicillin和質子幫浦阻斷劑組成之三合療法作第二線除菌處方，其滅菌成功率在某些地區高於標準四合療法，而且副作用較少。依「第三屆馬茲垂克治療共識」的建議：在作幽門螺旋桿菌的第三線治療時，宜將病人轉至醫學中心，並依幽門螺旋桿菌的抗生素敏感性試驗結果作除菌。但在臨床上，使用由質子幫浦阻斷劑、鉍劑、Amoxicillin和Levofloxacin所組成之10日四合療法作爲第三線除菌治療之處方，除菌率亦可高達84%。

關鍵字

幽門螺旋桿菌；第一線治療；第二線治療；第三線治療；抗藥性

並列摘要

Recently, increasing antimicrobial resistance of Helicobacter pylori (H. pylori) has resulted in falling eradication rates with standard therapies. Many treatment regimens have therefore emerged to effectively treat this infection. In this article, recent advances in the treatment of H. pylori are reviewed. Currently, the best validated first-line therapy for H. pylori infection by most international guidelines is standard triple therapy consisting of a proton pump inhibitor (PPI), clarithromycin and amoxicillin. Metronidazole can be used as an alternative to amoxicillin. However, this gold standard has become tarnished with failure rates increasing to more than 20% globally. A novel sequential regimen has been developed and achieves an eradication rate of 94% in first-line therapy. It is worth noting that a new 7-day quadruple therapy consisting of a PPI, clarithromycin, amoxicillin and metronidazole also achieve a high eradication rate. With regard to the second-line therapies, most guidelines suggest a quadruple therapy composed by a PPI, bismuth subcitrate, tetracycline and metronidazole. The eradication rates of the rescue regimen range from 37% to 95%. Recently, a triple therapy with the combination of a PPI, levofloxacin and amoxicillin has been proposed as an alternative to the standard rescue therapy. The rescue regimen achieved higher eradication rates than standard triple therapies in some regions and had less adverse effects. The Maastricht III Consensus Report suggested that patients requiring third-line therapy should be referred to medical center and treated according to the antibiotic susceptibility test. Nonetheless, a 10-day quadruple regimen comprising of a PPI, bismuth subcitrate, amoxicillin and levofloxacin can be administered and achieves an eradication rate of 84%.

並列關鍵字

Helicobater pylori ； First-line therapy ； Second-line therapy ； Third-line therapy ； Antimicrobial resistance

國際替代計量

幽門螺旋桿菌除菌治療之新進展

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