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Moderne Helicobacter-pylori-Therapien in Zeiten zunehmender Antibiotikaresistenz

Modern Helicobacter Pylori Therapies in Times of Increasing Anti biotic Resistance

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Zusammenfassung

Die Empfehlungen zu Diagnostik und Therapie der Helicobacter pylori Infektion sind in aktuellen, nationalen und internationalen Leitlinien definiert. In Deutschland gilt die Protonenpumpeninhibitoren(PPI)-basierte Tripeltherapie mit Clarithromycin und Metronidazol oder Amoxicillin als Standard der Primärbehandlung. Allerdings sind die Erfolgsraten dieser Standardtherapien in den letzten Jahren aufgrund zunehmender Antibiotikaresistenzen gesunken, insbesondere bei Patienten aus dem südeuropäischen Raum. Zudem kommt es nach Versagen der Primärtherapie zu einem dramatischen Anstieg der Resistenzraten, die einen erneuten Einsatz der Standardantibiotika praktisch unmöglich macht. Vor diesem Hintergrund ist eine regelmäßige kritische Prüfung und ggf. auch Anpassung der therapeutischen Optionen sowohl in der Primärbehandlung als auch in der Reservesituation erforderlich. Dieser Artikel gibt eine praxisrelevante Übersicht über den aktuellen Stand der therapeutischen Optionen der Helicobacter pylori Infektion vor dem Hintergrund zunehmender Antibiotikaresistenzen.

Abstract

Recommendation for the diagnosis and treatment of Helicobacter pylori Infection are defined in recent national and international guidelines. In Germany, proton pump inhibitor-based triple therapy with clarithromycin and metronidazole or amoxicillin is still the standard in first line therapy. However, success rates have decreased substantially during the last years due to increasing antibiotic resistance, particularly in patients from Southern Europe. In addition, antimicrobial resistance rates against the standard antibiotics further increases dramatically after failure of first line therapy deeming the repeated use of these antibiotics basically impossible. Against this background, a critical appraisal and eventaully adaption of therapeutic options both in first line and rescue treatment appears necessary. This paper gives an overview on the current status of therapeutic options and developments in the treatment of H. pylori infection in the light of increasing antibiotic resistance.

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Literatur

  1. Malfertheiner P, Megraud F, O'Morain C, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 2007;56:772–781.

    Article  CAS  PubMed  Google Scholar 

  2. Fischbach W, Malfertheiner P, Hoffmann JC, et al. S3-guideline „helicobacter pylori and gastroduodenal ulcer disease“ of the German society for digestive and metabolic diseases (DGVS) in cooperation with the German society for hygiene and microbiology, society for pediatric gastroenterology and nutrition e.V., German society for rheumatology, AWMF-registration-no. 021 / 001. Z Gastroenterol 2009;47:1230–1263.

    Article  CAS  PubMed  Google Scholar 

  3. Calvet X, García N, López T, et al. A meta-analysis of short versus long therapy with a proton pump inhibitor, clarithromycin and either metronidazole or amoxycillin for treating Helicobacter pylori infection. Aliment Pharmacol Ther 2000;14:603–609.

    Article  CAS  PubMed  Google Scholar 

  4. Fuccio L, Minardi ME, Zagari RM, et al. Metaanalysis: duration of first-line proton-pump inhibitor based triple therapy for Helicobacter pylori eradication. Ann Intern Med 2007;147:553–562.

    PubMed  Google Scholar 

  5. Graham DY, Fischbach L. Helicobacter pylori treatment in the era of increasing antibiotic resistance. Gut 2010;59:1143–1153.

    Article  CAS  PubMed  Google Scholar 

  6. Zullo A, De Francesco V, Hassan C, et al. The sequential therapy regimen for Helicobacter pylori eradication: a pooled-data analysis. Gut 2007;56:1353–1357.

    Article  CAS  PubMed  Google Scholar 

  7. Berning M, Krasz S, Miehlke S. Should quinolones come first in Helicobacter pylori therapy? Ther Adv Gastroenterol 2010; article in press.

  8. Gisbert JP. „Rescue“ regimens after Helicobacter pylori treatment failure. World J Gastroenterol 2008;14:5385–5402.

    Article  CAS  PubMed  Google Scholar 

  9. Morgner A, Labenz J, Miehlke S. Effective regimens for the treatment of Helicobacter pylori infection. Expert Opin Investig Drugs 2006;15:995–1016.

    Article  CAS  PubMed  Google Scholar 

  10. Gisbert JP, Morena F. Systematic review and metaanalysis: levofloxacin-based rescue regimens after Helicobacter pylori treatment failure. Aliment Pharmacol Ther 2006;23:35–44.

    Article  CAS  PubMed  Google Scholar 

  11. Berning M, Krasz S, Schneider-Brachert W, et al. Gastroenterol 2009;136(suppl 1):979

    Google Scholar 

  12. Carothers JJ, Bruce MG, Hennessy TW, et al. The relationship between previous fluoroquinolone use and levofloxacin resistance in Helicobacter pylori infection. Clin Infect Dis 2007;44:5–8.

    Article  Google Scholar 

  13. Chey WD, Wong BC. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol 2007;102:1808–1825.

    Article  CAS  PubMed  Google Scholar 

  14. Malfertheiner P, Megraud F, Giguere M, Riviere M. Quadruple therapy with bismuth subcitrate potassium, metronidazole, tetracycline, and omeprazole is superior to triple therapy with omeprazole, amoxicillin, and clarithromycin in the eradication of Helicobacter pylori. Gastroenterol 2010;116(suppl 1):179

    Google Scholar 

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Authors and Affiliations

  1. Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden, Germany

    Marco Berning & Susanne Krasz

  2. Innere Medizin, Diakonie Klinikum Jung-Stilling, Siegen, Germany

    Joachim Labenz

  3. Magen-Darm-Zentrum, Internistische Kooperation Eppendorf, Hamburg, Germany

    Stephan Miehlke

  4. Magen-Darm-Zentrum, Internistische Kooperation Eppendorf, Eppendorfer Landstr. 42, 20249, Hamburg, Germany

    Stephan Miehlke

Authors
  1. Marco Berning
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  2. Susanne Krasz
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  3. Joachim Labenz
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  4. Stephan Miehlke
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Corresponding author

Correspondence to Stephan Miehlke.

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Berning, M., Krasz, S., Labenz, J. et al. Moderne Helicobacter-pylori-Therapien in Zeiten zunehmender Antibiotikaresistenz. Med Klin 105, 787–791 (2010). https://doi.org/10.1007/s00063-010-1135-2

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  • DOI: https://doi.org/10.1007/s00063-010-1135-2

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