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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醫藥類 (14)
想請問因為今天去看胃鏡報告確定有胃幽們桿菌,醫生開給我1.Esomeprazol 40mg bid 2.Clarithromycin 500mg bid3.Amoxicillin 500mg bid那我是不是自己amoxicillin加到1g因為dose差一半ㄝ??
因為每個人狀況不同，所以劑量上都會有微調，建議你還是跟醫師討論，不要自行改變劑量
想請問：三合一療法可不可以用tetracycline+PPI+clarythromycin這個組合呢？
請問omeprazole 在血漿中的半生期（half-life）約為1-2小時，但是它卻可以每天給藥一次（20-40 mg QD PO），為什麼？？
不知道為什麼版主沒回三樓，可能沒空吧，事隔六年我來回一下三樓，我想這個omeprazole是緩釋劑型所以才會QD使用吧！
藥物問題礙於法規因素不在版面回覆
原來是這樣 懂得保護自己 學起來了謝謝學長 :)