幽門螺旋桿菌(Helicobacter pylori)為胃潰瘍中導致胃癌的危險因子之一,目前治療方式如下:
幽門螺旋桿菌的藥物治療2008 Helicobacter pylori Infections
regimen
期間
藥物1
藥物2
藥物3
藥物4
第一線
1
7-14天
Omeprazole
20mg bid
Clarithromycin
500mg bid
Amoxicillin
1 g bid
 
2
7-14天
Omeprazole
20mg bid
Clarithromycin
500mg bid
Metronidazole
500 mg bid
 
第二線
3
14天
Omeprazole
20mg bid
Bismuth subsalicylate
2tab qid
Tetracycline HCl
500 mg qid
Metronidazole
500 mg tid
附註:
1.          Meta-analyses show that a 14-day course of therapy is slightly superior to a 7-day course. However, the success rate for 7-day therapy is so high in northern Europe (>80%) that 7-day treatment is recommended in most guidelines.
2.          Omeprazole may be replaced with any proton pump inhibitor at an equivalent dosage or, in Regimens 1 and 2, with ranitidine bismuth citrate (400 mg).
3.          An alternative to this second-line therapy is to culture H. pylori and to be guided by antibiotic susceptibility data. Patients in whom second-line therapy fails should undergo endoscopy for H. pylori culture and antibiotic susceptibility testing.
4.          Data supporting this regimen come mainly from Europe and are based on the use of bismuth subcitrate and metronidazole (400 mg tid).
 
Harrison's Principles of Internal Medicine - 17th Ed.

幽門螺旋桿菌的傳統治療
治療組合
處方
劑量
治療期間(天數)
根除率(%)
二合一
PPI
qd or bid
14
70-80
Clarithromycin
500mg tid
PPI
Bid or tid
14
20-70
Amoxicillin
1 g bid-tid
Ranitidine Bismuth subcitrate
400mg bid(14天)
1000mg bid
28
77-82
Clarithromycin
500mg tid
14
治療組合
處方
劑量
治療期間(天數)
根除率(%)
三合一
PPI
Bid
Clarithromycin
500mg bid
10-14
86-92
Amoxicillin
1g bid
PPI
Bid
Clarithromycin
500mg bid
10-14
87-91
Metronidazole
500mg bid
PPI
Bid
Amoxicillin
500mg bid
10-14
77-83
Metronidazole
500mg bid
治療組合
處方
劑量
治療期間(天數)
根除率(%)
四合一
Bismuth subsalicylate
524mg qid
14
80-90
Metronidazole
250-500mg qid
Tetracycline
500mg qid
H2 blocker or PPI
Qd
Bismuth subsalicylate
524mg qid
14
80-90
Metronidazole
250-500mg qid
Clarithromycin
250-500mg qid
H2 blocker or PPI
Qd
Bismuth subsalicylate
500mg qid
14
70-85
Metronidazole
250-500mg qid
Amoxicillin
500mg qid
H2 blocker or PPI
qd
 

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