Analysis of methods of eradicating drug-resistant Helicobacter pylori with traditional Chinese and Western medicine

doi:10.3877/cma.j.issn.1674-0785.2021.09.014

Abstract

Abstract:

Helicobacter pylori (Hp) has a high infection rate and drug resistance rate. Effective prevention and treatment of Hp drug resistance are of great clinical significance. Identifying the best radical cure method is currently the main measure to eradicate or alleviate drug resistance. Based on the latest research progress in this field, this article classifies candidate drugs for the treatment of drug-resistant Hp, and selects better treatment options from the perspectives of Western medicine combined with traditional Chinese medicine, Western medicine combined with probiotics, and Western medicine combined with new drugs. We strongly recommend the regimen consisting of amoxicillin, clarithromycin, rabeprazole, bismuth potassium citrate, and berberine. The combined use of drugs provides new methods and new ideas for standardized radical treatment of Hp.

Key words: Helicobacter pylori, Drug resistance, Combination, Traditional Chinese medicine, Western medicine

Rujia Li, Yuanyuan Dai, Chun Qin, Lijuan Liao, Jiayin Xu, Xue Wang, Ganrong Huang, Xianke Luo, Yanqiang Huang. Analysis of methods of eradicating drug-resistant Helicobacter pylori with traditional Chinese and Western medicine[J]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(09): 716-720.

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References 36

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方法类型	药物选择、疗程和给药剂量	有效率
单纯西医治疗^［18］	（1）有药敏结果支持：2种敏感抗生素（2次/d）+奥美拉唑（20 mg，1次/d）+枸橼酸铋钾（0.3 g，2次/d）（2）无药敏结果支持：阿莫西林（0.5 g，2次/d）+除阿莫西林外任一敏感抗生素（根据用药史，2次/d）+奥美拉唑（20 mg，1次/d）+枸橼酸铋钾（0.3 g，2次/d）疗程：14 d	根除率约为85%
中西医联合治疗^［17］	西药：阿莫西林（0.457 g，2次/d）+克拉霉素（0.5 g，2次/d）+雷贝拉唑（20 mg，1 次/d）中药：半夏泻心汤（2次/d）疗程：14 d	联合治疗：92.11%单用西药治疗：71.05%
益生菌联合治疗^［19］	西药：阿莫西林（1.0 g，2次/d）+克拉霉素（500 mg，2次/d）+雷贝拉唑（20 mg，1 次/d）+枸橼酸铋钾（0.2 g，2次/d）益生菌：嗜酸乳杆菌（1.0 g，3次/d）疗程：14 d	联合治疗：92.3% 单用西药治疗：83.9%
新型药物联合治疗^［20］	西药：兰索拉唑（30 mg，2次/d），阿莫西林（500 mg，2次/d），和克拉霉素（400 mg，2次/d）新型药物：聚普瑞锌疗程：7 d	联合治疗：94% 单用西药治疗：77%

方法类型	药物选择、疗程和给药剂量	有效率
单纯西医治疗^［18］	（1）有药敏结果支持：2种敏感抗生素（2次/d）+奥美拉唑（20 mg，1次/d）+枸橼酸铋钾（0.3 g，2次/d）（2）无药敏结果支持：阿莫西林（0.5 g，2次/d）+除阿莫西林外任一敏感抗生素（根据用药史，2次/d）+奥美拉唑（20 mg，1次/d）+枸橼酸铋钾（0.3 g，2次/d）疗程：14 d	根除率约为85%
中西医联合治疗^［17］	西药：阿莫西林（0.457 g，2次/d）+克拉霉素（0.5 g，2次/d）+雷贝拉唑（20 mg，1 次/d）中药：半夏泻心汤（2次/d）疗程：14 d	联合治疗：92.11%单用西药治疗：71.05%
益生菌联合治疗^［19］	西药：阿莫西林（1.0 g，2次/d）+克拉霉素（500 mg，2次/d）+雷贝拉唑（20 mg，1 次/d）+枸橼酸铋钾（0.2 g，2次/d）益生菌：嗜酸乳杆菌（1.0 g，3次/d）疗程：14 d	联合治疗：92.3% 单用西药治疗：83.9%
新型药物联合治疗^［20］	西药：兰索拉唑（30 mg，2次/d），阿莫西林（500 mg，2次/d），和克拉霉素（400 mg，2次/d）新型药物：聚普瑞锌疗程：7 d	联合治疗：94% 单用西药治疗：77%

方案	药物及幽门螺杆菌根除率	不良反应
三联疗法	（1）奥美拉唑+克拉霉素+阿莫西林（71.21%~78.4%）^{［30, 31］} （2）雷贝拉唑+阿莫西林+克拉霉素（71.19%）^［32］（3）泮托拉唑+阿莫西林+克拉霉素（75%）^［33］	恶心、呕吐、腹泻、腹胀^{［30, 31, 32, 33］}（66%~66.7%）
四联疗法	（1）铋剂+雷贝拉唑+阿莫西林+克拉霉素（80%）^［34］（2）铋剂+雷贝拉唑+阿莫西林+呋喃唑酮（80%）^［35］（3）铋剂+奥美拉唑+阿莫西林+克拉霉素（64%）^［36］	腹痛、腹胀、恶心、味觉改变^［36］（95%）
黄连素联合三联疗法	（1）黄连素+奥美拉唑+克拉霉素+阿莫西林（88.6%~92%）^{［29, 30, 31］} （2）黄连素+雷贝拉唑+阿莫西林+克拉霉素（89.29%）^［32］（3）黄连素+泮托拉唑+阿莫西林+克拉霉素（92.5%）^［33］	恶心、腹胀^{［29, 30, 31, 32, 33］}（42%~46.7%）
黄连素联合四联疗法	（1）黄连素+铋剂+雷贝拉唑+阿莫西林+克拉霉素（94%）^［34］（2）黄连素+铋剂+雷贝拉唑+阿莫西林+呋喃唑酮（90%）^［35］（3）黄连素+铋剂+奥美拉唑+阿莫西林+克拉霉素（82%）^［36］	腹痛、腹胀、味觉改变^［36］（45%）

方案	药物及幽门螺杆菌根除率	不良反应
三联疗法	（1）奥美拉唑+克拉霉素+阿莫西林（71.21%~78.4%）^{［30, 31］} （2）雷贝拉唑+阿莫西林+克拉霉素（71.19%）^［32］（3）泮托拉唑+阿莫西林+克拉霉素（75%）^［33］	恶心、呕吐、腹泻、腹胀^{［30, 31, 32, 33］}（66%~66.7%）
四联疗法	（1）铋剂+雷贝拉唑+阿莫西林+克拉霉素（80%）^［34］（2）铋剂+雷贝拉唑+阿莫西林+呋喃唑酮（80%）^［35］（3）铋剂+奥美拉唑+阿莫西林+克拉霉素（64%）^［36］	腹痛、腹胀、恶心、味觉改变^［36］（95%）
黄连素联合三联疗法	（1）黄连素+奥美拉唑+克拉霉素+阿莫西林（88.6%~92%）^{［29, 30, 31］} （2）黄连素+雷贝拉唑+阿莫西林+克拉霉素（89.29%）^［32］（3）黄连素+泮托拉唑+阿莫西林+克拉霉素（92.5%）^［33］	恶心、腹胀^{［29, 30, 31, 32, 33］}（42%~46.7%）
黄连素联合四联疗法	（1）黄连素+铋剂+雷贝拉唑+阿莫西林+克拉霉素（94%）^［34］（2）黄连素+铋剂+雷贝拉唑+阿莫西林+呋喃唑酮（90%）^［35］（3）黄连素+铋剂+奥美拉唑+阿莫西林+克拉霉素（82%）^［36］	腹痛、腹胀、味觉改变^［36］（45%）

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