Рекомендации Маастрихт V/Флорентийского консенсуса по лечению хеликобактерной инфекции
Рекомендации Маастрихт V/Флорентийского консенсуса по лечению хеликобактерной инфекции
Пиманов С.И., Макаренко Е.В. Рекомендации Маастрихт V/Флорентийского консенсуса по лечению хеликобактерной инфекции. Consilium Medicum. 2017; 19 (8.1. Гастроэнтерология): 8–27.
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Pimanov S.I., Makarenko E.V. Recommendations of the Maastricht V/Florence consensus for the Helicobacter pylori treatment. Consilium Medicum. 2017; 19 (8.1. Gastroenterology): 8–27.
Рекомендации Маастрихт V/Флорентийского консенсуса по лечению хеликобактерной инфекции
Пиманов С.И., Макаренко Е.В. Рекомендации Маастрихт V/Флорентийского консенсуса по лечению хеликобактерной инфекции. Consilium Medicum. 2017; 19 (8.1. Гастроэнтерология): 8–27.
________________________________________________
Pimanov S.I., Makarenko E.V. Recommendations of the Maastricht V/Florence consensus for the Helicobacter pylori treatment. Consilium Medicum. 2017; 19 (8.1. Gastroenterology): 8–27.
Цель работы – анализ посвященного лечению инфекции Helicobacter pylori (H.pylori) раздела Маастрихт-V-Флорентийского консенсуса. Резистентность H. pylori к антибиотикам растет в большинстве регионов мира. Для некоторых эрадикационных протоколов уровень эрадикации может быть предопределен, если известна как частота эрадикации для чувствительных и резистентных штаммов, так и распространенность резистентности в популяции. Для оценки индивидуальной антибиотикорезистентности конкретного пациента следует учитывать применение им ключевых антибиотиков в анамнезе, а не только низкий уровень резистентности к этим антибиотикам в популяции. Оценка результатов чувствительности должна основываться как на популяционных, так и на индивидуальных данных. В регионах с высокой (>15%) резистентностью к кларитромицину рекомендуется квадротерапия с висмутом или без висмута, а также сопутствующая терапия (ингибитор протонной помпы – ИПП, амоксициллин, кларитромицин и нитроимидазол). В регионах с высокой резистентностью к кларитромицину и метронидазолу одновременно висмутсодержащая квадротерапия рекомендуется в качестве терапии первой линии. Продолжительность эрадикационной квадротерапии с висмутом должна быть удлинена до 14 дней, хотя для отдельных регионов доказана эффективность 10-дневной терапии. Продолжительность эрадикационной тройной терапии с кларитромицином должна быть удлинена до 14 дней. В регионах с низкой резистентностью к кларитромицину стандартная ИПП-кларитромицин-содержащая тройная терапия рекомендуется в качестве эмпирической терапии первой линии. Висмутсодержащая квадротерапия является альтернативой. Использование высоких доз ИПП дважды в день повышает эффективность тройной терапии. Эзомепразол и рабепразол могут быть предпочтительны в Европе и Северной Америке, где распространенность экстенсивных метаболизаторов ИПП высокая. После безуспешности висмутсодержащей квадротерапии может быть рекомендована фторхинолонсодержащая тройная или квадротерапия. В случаях высокой резистентности к хинолонам оптимальной может быть комбинация висмута с другими антибиотиками или рифабутином. В целом при сравнении с предыдущим консенсусом для лечения хеликобактерной инфекции предлагается более агрессивная антибиотикотерапия.
The purpose of the work is to analyze section of the Maastricht-V-Florence consensus dedicated of Helicobacter pylori (H.pylori) infection treatment. H. pylori resistance rates to antibiotics are increasing in most parts of the world. For any regimen, the eradication rate can be predicted if the cure rates are known for susceptible and resistant strains and the prevalence of resistance in the population. For an individual patient a history of any prior use of one of the key antibiotics proposed will identify likely antibiotic resistance despite low resistance rates in the population. Susceptibility based results simultaneously provide results that are both population- and individual-based. In areas of high (>15%) clarithromycin resistance, bismuth quadruple or non-bismuth quadruple, concomitant (proton pump inhibitor – PPI, amoxicillin, clarithromycin and a nitroimidazole) therapies are recommended. In areas of high dual clarithromycin and metronidazole resistance, bismuth quadruple therapy is the recommended first-line treatment. The treatment duration of bismuth quadruple therapy should be extended to 14 days, unless 10 day therapies are proven effective locally. The treatment duration of triple therapy with clarithromycin should be extended to 14 days. In areas of low clarithromycin resistance, triple therapy is recommended as first-line empirical treatment. Bismuth-containing quadruple therapy is an alternative. The use of high dose PPI twice daily increases the efficacy of triple therapy. Esomeprazole and rabeprazole may be preferred in Europe and North America where the prevalence of PPI extensive metabolisers is high. After failure of bismuth-containing quadruple therapy, a fluoroquinolone-containing triple or quadruple therapy may be recommended. In cases of high quinolone resistance, the combination of bismuth with other antibiotics, or rifabutin, may be an option. In general, when compared with the previous consensus, for the treatment of H. pylori infection more aggressive antibiotic therapy is offered.
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1. Malfertheiner P, Megraud F, O’Morain C et al. Current concepts in the management of Helicobacter pylori infection – The Maastricht 2-2000 Consensus Report. Aliment Pharmacol Ther 2002; 16: 167–80.
2. Malfertheiner P, Megraud F, O’Morain CA et al. Current concepts in the management of Helicobacter pylori infection – The Maastricht III Consensus Report. Gut 2007; 56: 772–81.
3. Malfertheiner P, Megraud F, O’Morain CA et al. Management of Helicobacter pylori infection – the Maastricht IV/ Florence Consensus Report. Gut 2012; 61: 646–64.
4. Malfertheiner P, Megraud F, O'Morain C et al. Management of Helicobacter pylori infection – the Maastricht V/Florence Consensus Report. Gut 2017; 66 (1): 6–30.
5. Sugano К, Tack J, Kuipers EJ et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut 2015; 64: 1353–67.
6. Zagari RM, Romano M, Ojetti V et al. Guidelines for the management of Helicobacter pylori infection in Italy: The III Working Group Consensus Report 2015. Dig Liver Dis 2015; 47: 903–12.
7. Fallone CA, Chiba N, van Zanten SV et al. The Toronto consensus for the treatment of Helicobacter pylori infection in adults. Gastroenterology 2016; 151 (1): 51–69.
8. Graham D, Laine L. Toronto H. pylori Consensus Recommendations in Context. Gastroenterology 2016; 151 (1): 9–12.
9. Thung I, Aramin H, Vavinskaya V et al. Review article: the global emergence of Helicobacter pylori antibiotic resistance. Aliment Pharmacol Ther 2016; 43: 514–33.
10. Ford AC, Malfertheiner P, Giguere M et al. Adverse events with bismuth salts for Helicobacter pylori eradication: systematic review and meta-analysis. World J Gastroenterol 2008; 14: 7361–70.
11. Pimanov S.I., Makarenko E.V. Analiz effektivnosti protokolov eradikatsii infektsii Helicobacter pylori. Retsept. 2005; 1: 19–23. [in Russian]
12. Federico A, Nardone G, Gravina AG et al. Efficacy of 5-day levofloxacin-containing concomitant therapy in eradication of Helicobacter pylori infection. Gastroenterology 2012; 143: 55–61.e1; quiz e13–14.
13. Toracchio S, Capodicasa S, Soraja DB et al. Rifabutin based triple therapy for eradication of H. pylori primary and secondary resistant to tinidazole and clarithromycin. Dig Liver Dis 2005; 37: 33–8.
14. Ince AT, Tozlu M, Baysal B et al. Yields of dual therapy containing high-dose proton pump inhibitor in eradication of H. pylori positive dyspeptic patients. Hepatogastroenterology 2014; 61: 1454–8.
15. Romano M, Fernandez-Bermejo M, Gravina AG et al. Optimized Nonbismuth Quadruple Therapies Cure Most Patients With Helicobacter pylori Infection in Populations With High Rates of Antibiotic Resistance. Gastroenterology 2013: 145 (1): 121–8.
16. Zullo A, Scaccianoce G, De Francesco V et al. Concomitant, sequential, and hybrid therapy for H. pylori eradication: a pilot study. Clin Res Hepatol Gastroenterol 2013; 37: 647–50.
17. Liu WZ, Xie Y, Cheng H et al. Fourth Chinese National Consensus Report on the management of Helicobacter pylori infection. J Dig Dis 2013; 14: 211–21.
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Авторы
С.И.Пиманов*, Е.В.Макаренко
УО «Витебский государственный ордена Дружбы народов медицинский университет». 210023, Республика Беларусь, Витебск, пр-т Фрунзе, д. 27
*pimanovs@tut.by
________________________________________________
S.I.Pimanov*, E.V.Makarenko
Vitebsk State Order of Peoples' Friendship Medical University. 210023, Republic of Belarus, Vitebsk, pr-t Frunze, d. 27
*pimanovs@tut.by