摘要
H pylori gastric infection is one of the most prevalent infectious diseases worldwide. The discovery that most upper gastrointestinal diseases are related to Hpylori infection and therefore can be treated with antibiotics is an important medical advance. Currently, a first-line triple therapy based on proton pump inhibitor （PPI） or ranitidine bismuth citrate （RBC） plus two antibiotics （darithromycin and amoxicillin or nitroimidazole） is recommended by all consensus conferences and guidelines. Even with the correct use of this drug combination, infection can not be eradicated in up to 23% of patients. Therefore, several second line therapies have been recommended. A 7 d quadruple therapy based on PPI, bismuth, tetracycline and metronidazole is the more frequently accepted. However, with second-line therapy, bacterial eradication may fail in up to 40% of cases. When Hpylori eradication is striclly indicated the choice of further treatment is controversial. Currently, a standard third-line therapy is lacking and various protocols have been proposed. Even after two consecutive failures, the most recent literature data have demonsbated that Hpylori eradication can be achieved in almost all patients, even when antibiotic susceptibility is not tested. Different possibilities of empirical treatment exist and the available third-line strategies are herein reviewed.
H pylori 胃的感染是世界范围的最流行的传染病之一。很上面的胃肠的疾病与 H pylori 感染有关能因此与抗菌素被对待的发现是重要医药进展。当前，首要的三倍的治疗被所有一致会议和指南基于质子泵禁止者(PPI ) 或加二抗菌素(clarithromycin 和 amoxicillin 或 nitroimidazole ) 的 ranitidine 枸橼酸铋(RBC ) 推荐。甚至与这药联合的正确使用，感染不能在多达 23% 病人被根除。因此，几第二线治疗被推荐了。7 d 四倍的治疗基于 PPI，铋，四圜素和灭滴灵，更多经常被接受。与第二线的治疗，然而，细菌的根除可以在多达 40% 盒子失败。当 H pylori 根除严格地被显示时，进一步的治疗的选择是争论的。当前，标准第三线的治疗正在缺乏，各种各样的协议被建议了。甚至在二连续失败以后，最近的文学数据证明了 H pylori 根除能在几乎所有病人被完成，甚至当抗菌素危险性没被测试时。实验治疗的不同可能性存在，可得到的第三线的策略此处被考察。
