幽門螺旋桿菌根除療法之新趨勢

The New Trends of 'Helicobacter pylori' Eradication Therapy

幽門螺旋桿菌感染，是一種普遍存在的疾病，平均的盛行率約為50－60％。研究顯示，幽門螺旋桿菌除了會引起胃炎及胃潰瘍外，也與胃癌及胃淋巴癌形成有關。近年來，由於對clarithromycin抗藥性的產生，使得標準三合一療法對幽門螺旋桿菌的根除率漸漸變差。針對低clarithromycin抗藥性的區域，標準三合一療法可以作為第一線的療法，而bismuth四合一療法、序列性療法（sequential therapy）及同步性療法（concomitant therapy）可作為第一線的替代療法；但在高clarithromycin抗藥性的區域，標準三合一療法則不建議作為第一線的療法，可以直接選用bismuth四合一療法、序列性療法或同步性療法，作為第一線的療法，若治療失敗，再考慮選用以levofloxacin為基礎的療法（levofloxacin-based therapy）、抗生素敏感試驗療法（culture-guided therapy）或以rifabutin為基礎的療法（rifabutin-based therapy）作為替代療法。

Helicobacter pylori infection is a common disease, the average prevalence is about 50-60%. Studies have shown that 'H. pylori' can cause gastritis, peptic ulcer, gastric cancer and gastric lymphoma. In recent years, because the generation of clarithromycin resistance, reduced the 'H. pylori' eradication rates of standard triple therapy. In low clarithromycin resistance area, can use the standard triple therapy as the first-line therapy, and the standard quadruple therapy, sequential therapy or concomitant therapy can be as an alternative first-line therapy; but in high resistance clarithromycin areas, can select directly quadruple therapy, sequential therapy or concomitant therapy as the first-line therapy, if the treatment has failed, can use levofloxacin-based therapy, culture-guided therapy or rifabutin-based therapy as an alternative therapy.