兒童幽門螺旋桿菌治療的最新發展

The Treatment of Helicobacter Pylori Infection in Children

廖宜新(Yi-Hsin Liao) ； 吳子聰(Tzee-Chung Wu)

《Acta Paediatrica Taiwanica》 45卷s期 (2004/11) Pp. 54-59

https://doi.org/10.7097/APT.200411.0054

摘要

幽門螺旋桿菌感染主要發生在兒童及青少年期。對於兒童幽門螺旋桿菌感染，上消化道內視鏡加上切片檢查或吹氣試驗是目前較爲建議的診斷工具。對於第一次治療失敗後的追蹤，上消化道內視鏡加上取得細菌檢體及抗生素第三試驗也是目前臨床上重要的方法。目前三合一療法被認爲是根除幽門螺旋桿菌的第一線黃金標準治療。即7天的三種藥物聯合治療：包括使用(1)氫離子阻斷劑或ranitidine bismuth citrate，與(2)clarithromycin和(3)amoxicillin或metronidazole，都是口服一天兩次，根除率約可達到75-92%。而抗藥性的産生是治療失敗的最重要因素，可以是原發於細菌本身的突變、或是治療過程中使用不當的劑量及療程。第二線根除療法使用於第一線療法治療失敗之後，即使用7天的四合一療法：氫離子阻斷劑、bismuth、metronidazole及tetracycline，根除率約77-82%。四合一療法有許多潛在的問題可能導治療失敗。但是關於第三線根除療法目前並沒有共識。未來仍需要更多的研究來找出其他種替代治療來治療多得根除失敗的病人。

關鍵字

幽門螺旋桿菌 ； 根除治療 ； 抗生素

並列摘要

Helicobacter pylon infection mainly occurs in the child and the adolescent. Regarding the infection of Helicobacter pylon in children, upper gastrointestinal panendoscopy with biopsy or the urea breathing test are the diagnostic tools, which at present suggested. As to failure of the first treatment, upper gastrointestinal panendoscopy to obtain the pathological specimen and the antibiotic sensitive test also are the present clinically important method. At present, three-combined therapy was considered the first line gold standard treatment to eradicate the Helicobacter pylon infection. That is, 7-day three kinds of medicines union treatment: (1) the hydrogen pump inhibitor or ranitidine bismuth citrate, with (2) clarithromycin and (3) amoxicillin or metronidazole: all are taken orally twice daily. The eradication rate may achieve approximately 75-92%. But resistance to antibiotic is the most important attribution to treatment failure; it may be due to mutation of bacterium itself, or the improper dosage and protocol in the treatment course. The second line eradication therapy began after failure of the first line therapy. The second-line eradication therapy should be a 7-day quadruple therapy with a proton pump inhibitor, bismuth, metronidazole and tetracycline. The eradication rate achieves approximately 77-82%. Quadruple therapy has many latent questions possibly to cause treatment failure. But, there is no consensus at present, about the third-line eradication therapy. In the future, we still need more research to discover the other alternative management to treat the patient with multiple failure of eradication treatment.