含铋剂四联疗法治疗幽门螺杆菌感染药物选择

Alternative medications for management of helicobacter pylori infection with bismuth-containing quadruple therapy

由于抗生素耐药率的不断上升,对幽门螺杆菌(Hp)感染的含铋剂的四联根除方案再次受到重视。最新的欧洲马斯特里赫特(Maastricht)Ⅳ和中国幽门螺杆菌共识均将铋剂四联方案作为推荐方案。抗生素的选择上应结合药物间相互作用、Hp对抗生素的耐药性综合考虑。质子泵抑制剂(PPI)的选择则要结合CYP2C19基因多态性,尽量选用受其影响较小的药物。铋剂短期应用安全性较高,但肾功能不全者应慎用。

The bismuth-containing quadruple therapy for eradication of Helicobacter pylori （H. pylori） has, owing to the increasing incidence of antibiotic resistance, become a crucial issue. Bismuth-containing quadruple therapy has been recommended by Maastricht IV and Chinese I-I. pylori infection consensus. The medication interactions and antibiotic resistance should be carefully considered when selecting the antibiotics. CYP2C19 gene polymorphism should be taken into account for selecting proton pump inhibitors. Short-term application of bismuth has high safety but should be administered cautiously in patients with renal insufficiency.