Takaisin Tulosta

Aikuisten helikobakteeri-infektion hoito

Lisätietoa aiheesta
alkuperäinen kirjoittaja: Seppo Niemelä; tarkastettu 10.4.2019
1.11.2012

Hoitovaihtoehtoja

Helikobakteerin hoidon tehoon vaikuttavia tekijöitä

Antibioottiherkkyys

Taulukko 1. Aikuisten helikobakteeri-infektion hoito herkkyysmäärityksen perusteella.
Herkkyysmäärityksen tulos Hoito
1) Omepratsoli 20 mg, esomepratsoli 20 mg, lansopratsoli 30 mg, pantopratsoli 40 mg tai rabepratsoli 20 mg
2) Hoitoa kannattaa jatkaa 2 viikkoon, jos kyseessä on uusintahoito
Metronidatsoliherkkä Happopumpun salpaajan normaali annos1) + metronidatsoli 400 mg + amoksisilliini 1 g, kaikki × 2 /vrk 1–2 2) viikon ajan
Penisilliiniyliherkillä amoksisilliinin voi korvata tetrasykliini 500 mg x 4/vrk
Metronidatsoliresistentti ja klaritromysiiniherkkä Happopumpun salpaajan normaali annos 1) + klaritromysiini 500 mg + amoksisilliini 1 g, kaikki × 2 /vrk 1–2 2) viikon ajan
Penisilliiniyliherkillä amoksisilliinin voi korvata tetrasykliini 500 mg x 4/vrk
Metronidatsoli- ja klaritromysiiniresistentti Happopumpun salpaajan normaali annos1) + amoksisilliini 1 g, molemmat x 2/vrk viiden vuorokauden ajan ja sitten happopumpun salpaaja normaali annos1) x 2/vrk + klaritromysiini 500 mg x 2/vrk (tai levofloksasiini 250 mg x 2/vrk) + metronidatsoli 400 mg x 3/vrk viiden vuorokauden ajan
TAI
Neloshoidossa happopumpun salpaajan normaali annos x 2/vrk + amoksisilliini 1 g x 2/vrk + metronidatsoli 500 mg x 2/vrk + klaritromysiini 500 mg x 2/vrk 10–14 vuorokauden ajan

Kirjallisuutta

  1. Koivisto TT, Rautelin HI, Voutilainen ME ym. First-line eradication therapy for Helicobacter pylori in primary health care based on antibiotic resistance: results of three eradication regimens. Aliment Pharmacol Ther 2005;21:773-82 «PMID: 15771764»PubMed
  2. Saad RJ, Schoenfeld P, Kim HM ym. Levofloxacin-based triple therapy versus bismuth-based quadruple therapy for persistent Helicobacter pylori infection: a meta-analysis. Am J Gastroenterol 2006;101:488-96 «PMID: 16542284»PubMed
  3. Kostamo P, Veijola L, Oksanen A ym. Recent trends in primary antimicrobial resistance of Helicobacter pylori in Finland. Int J Antimicrob Agents 2011;37:22-5 «PMID: 21084175»PubMed
  4. Assem M, El Azab G, Rasheed MA ym. Efficacy and safety of Levofloxacin, Clarithromycin and Esomeprazol as first line triple therapy for Helicobacter pylori eradication in Middle East. Prospective, randomized, blind, comparative, multicenter study. Eur J Intern Med 2010;21:310-4 «PMID: 20603042»PubMed
  5. Nista EC, Candelli M, Zocco MA ym. Levofloxacin-based triple therapy in first-line treatment for Helicobacter pylori eradication. Am J Gastroenterol 2006;101:1985-90 «PMID: 16968503»PubMed
  6. Zullo A, De Francesco V, Hassan C ym. The sequential therapy regimen for Helicobacter pylori eradication: a pooled-data analysis. Gut 2007;56:1353-7 «PMID: 17566020»PubMed
  7. Romano M, Cuomo A, Gravina AG ym. Empirical levofloxacin-containing versus clarithromycin-containing sequential therapy for Helicobacter pylori eradication: a randomised trial. Gut 2010;59:1465-70 «PMID: 20947881»PubMed
  8. De Francesco V, Margiotta M, Zullo A ym. Clarithromycin-resistant genotypes and eradication of Helicobacter pylori. Ann Intern Med 2006;144:94-100 «PMID: 16418408»PubMed
  9. Graham DY, Fischbach L. Helicobacter pylori treatment in the era of increasing antibiotic resistance. Gut 2010;59:1143-53 «PMID: 20525969»PubMed
  10. Wu DC, Hsu PI, Wu JY ym. Sequential and concomitant therapy with four drugs is equally effective for eradication of H pylori infection. Clin Gastroenterol Hepatol 2010;8:36-41.e1 «PMID: 19804842»PubMed
  11. Miehlke S, Hansky K, Schneider-Brachert W ym. Randomized trial of rifabutin-based triple therapy and high-dose dual therapy for rescue treatment of Helicobacter pylori resistant to both metronidazole and clarithromycin. Aliment Pharmacol Ther 2006;24:395-403 «PMID: 16842467»PubMed
  12. Fuccio L, Minardi ME, Zagari RM ym. Meta-analysis: duration of first-line proton-pump inhibitor based triple therapy for Helicobacter pylori eradication. Ann Intern Med 2007;147:553-62 «PMID: 17938394»PubMed
  13. Malfertheiner P, Megraud F, O'Morain C ym. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 2007;56:772-81 «PMID: 17170018»PubMed
  14. Lee JH, Jung HY, Choi KD ym. The Influence of CYP2C19 Polymorphism on Eradication of Helicobacter pylori: A Prospective Randomized Study of Lansoprazole and Rabeprazole. Gut Liver 2010;4:201-6 «PMID: 20559522»PubMed
  15. Vergara M, Vallve M, Gisbert JP ym. Meta-analysis: comparative efficacy of different proton-pump inhibitors in triple therapy for Helicobacter pylori eradication. Aliment Pharmacol Ther 2003;18:647-54 «PMID: 12969092»PubMed
  16. Graham DY, Lew GM, Malaty HM ym. Factors influencing the eradication of Helicobacter pylori with triple therapy. Gastroenterology 1992;102:493-6 «PMID: 1732120»PubMed
  17. Fischbach L, Evans EL. Meta-analysis: the effect of antibiotic resistance status on the efficacy of triple and quadruple first-line therapies for Helicobacter pylori. Aliment Pharmacol Ther 2007;26:343-57 «PMID: 17635369»PubMed
  18. Koivisto TT, Rautelin HI, Voutilainen ME ym. Primary Helicobacter pylori resistance to metronidazole and clarithromycin in the Finnish population. Aliment Pharmacol Ther 2004;19:1009-17 «PMID: 15113368»PubMed
  19. Huang J, Hunt RH. The importance of clarithromycin dose in the management of Helicobacter pylori infection: a meta-analysis of triple therapies with a proton pump inhibitor, clarithromycin and amoxycillin or metronidazole. Aliment Pharmacol Ther 1999;13:719-29 «PMID: 10383500»PubMed
  20. Wenzhen Y, Yumin L, Quanlin G ym. Is antimicrobial susceptibility testing necessary before first-line treatment for Helicobacter pylori infection? Meta-analysis of randomized controlled trials. Intern Med 2010;49:1103-9 «PMID: 20558925»PubMed