Updates on Management of Helicobacter pylori Infection and Antibiotic Resistant Helicobacter Infection Management

S. A. Nursyirwan, M. Simadibrata
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Abstract

H. pylori is a common human pathogen and it is estimated that approximately 50% of the world's population are infected. Furthermore it's prevalence infection in Indonesia is 20% but much higher among several ethnic groups (Papuans 42.9%, Batak 40.0%, and Bugis 36.7%). H. pylori’s growth and survival has been shown to be sensitive to a variety of antimicrobial agents. The success of the treatment depends on susceptibility, dosage, formulation, dose frequency, the use of adjuvants such as anti-secretory drugs, antacids or probiotics, and duration of treatment. The treatment for H. pylori infection keep evolving and the triple therapy, levofloxacin, was replaced by CLR in triple therapy for 14-day with eradication rates over 90%. Sequential therapy, also achieved a higher cure rate against clarithromycin-resistant strains than a 7 and 10 day triple therapy. Triple bismuth therapy and quadruple bismuth therapy are used less frequently due to their inherent complexity, the large number of tablets four times a day, side effects, and lack of support from pharmaceutical companies. Inclusively, vonoprazan is also a good choice that is fully effective from day one. The role of the probiotics is unclear and is not recommended in consensus groups. Two mucolytic agents, erdosteine and N-acetylcysteine (NAC), were found to increase it's eradication efficiency clinical trials when administered in supplementation with triple therapy but are not commonly used because of the need for high doses, and increased medical costs. therefore, H. pylori resistant management should be adapted to the results of the the culture of resistance and the guidelines of existing resistance patterns.
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幽门螺杆菌感染及耐药幽门螺杆菌感染管理进展
幽门螺杆菌是一种常见的人类病原体,据估计,世界上大约50%的人口被感染。此外,它在印度尼西亚的流行感染率为20%,但在几个民族中要高得多(巴布亚人42.9%,巴塔克人40.0%,布吉人36.7%)。幽门螺杆菌的生长和存活已被证明对多种抗菌剂敏感。治疗的成功取决于易感性、剂量、配方、给药频率、佐剂(如抗分泌药物、抗酸药或益生菌)的使用以及治疗的持续时间。幽门螺杆菌感染的治疗方法不断发展,在三联治疗中,左氧氟沙星被CLR取代,持续14天,根除率超过90%。序贯治疗对克拉霉素耐药菌株的治愈率也高于7天和10天的三联治疗。三重铋疗法和四倍铋疗法由于其固有的复杂性、每天四次的大量片剂、副作用以及缺乏制药公司的支持,使用频率较低。同时,伏诺哌赞也是一个很好的选择,从第一天起就完全有效。益生菌的作用尚不清楚,不建议在共识组中使用。临床试验发现,在三联疗法的补充下使用两种黏液溶解剂,即埃尔多卡因和n -乙酰半胱氨酸(NAC),可以提高其根除效率,但由于需要高剂量,并且增加了医疗费用,因此不常使用。因此,幽门螺杆菌耐药管理应适应耐药培养的结果和现有耐药模式的指导方针。
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42
审稿时长
8 weeks
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