PDF(Pubmed)
Abstract：
BACKGROUND: There has been an increase in resistance to many of the antimicrobials used to treat Helicobacter pylori ( H. pylori ) nationally and internationally. Primary clarithromycin resistance and dual clarithromycin and metronidazole resistance are high in Ireland. These trends call for an evaluation of best-practice management strategies.
OBJECTIVE: The objective of this study was to revise the recommendations for the management of H. pylori infection in adult patients in the Irish healthcare setting.
METHODS: The Irish H. pylori working group (IHPWG) was established in 2016 and reconvened in 2023 to evaluate the most up-to-date literature on H. pylori diagnosis, eradication rates and antimicrobial resistance. The \'GRADE\' approach was then used to rate the quality of available evidence and grade the resulting recommendations.
RESULTS: The Irish H. pylori working group agreed on 14 consensus statements. Key recommendations include (1) routine antimicrobial susceptibility testing to guide therapy is no longer recommended other than for clarithromycin susceptibility testing for first-line treatment (statements 6 and 9), (2) clarithromycin triple therapy should only be prescribed as first-line therapy in cases where clarithromycin susceptibility has been confirmed (statement 9), (3) bismuth quadruple therapy (proton pump inhibitor, bismuth, metronidazole, tetracycline) is the recommended first-line therapy if clarithromycin resistance is unknown or confirmed (statement 10), (4) bismuth quadruple therapy with a proton pump inhibitor, levofloxacin and amoxicillin is the recommended second-line treatment (statement 11) and (5) rifabutin amoxicillin triple therapy is the recommend rescue therapy (statement 12).
CONCLUSIONS: These recommendations are intended to provide the most relevant current best-practice guidelines for the management of H. pylori infection in adults in Ireland.
OBJECTIVE: The objective of this study was to revise the recommendations for the management of H. pylori infection in adult patients in the Irish healthcare setting.
METHODS: The Irish H. pylori working group (IHPWG) was established in 2016 and reconvened in 2023 to evaluate the most up-to-date literature on H. pylori diagnosis, eradication rates and antimicrobial resistance. The \'GRADE\' approach was then used to rate the quality of available evidence and grade the resulting recommendations.
RESULTS: The Irish H. pylori working group agreed on 14 consensus statements. Key recommendations include (1) routine antimicrobial susceptibility testing to guide therapy is no longer recommended other than for clarithromycin susceptibility testing for first-line treatment (statements 6 and 9), (2) clarithromycin triple therapy should only be prescribed as first-line therapy in cases where clarithromycin susceptibility has been confirmed (statement 9), (3) bismuth quadruple therapy (proton pump inhibitor, bismuth, metronidazole, tetracycline) is the recommended first-line therapy if clarithromycin resistance is unknown or confirmed (statement 10), (4) bismuth quadruple therapy with a proton pump inhibitor, levofloxacin and amoxicillin is the recommended second-line treatment (statement 11) and (5) rifabutin amoxicillin triple therapy is the recommend rescue therapy (statement 12).
CONCLUSIONS: These recommendations are intended to provide the most relevant current best-practice guidelines for the management of H. pylori infection in adults in Ireland.
摘要：
背景：对用于治疗幽门螺杆菌的许多抗菌剂的耐药性有所增加（H。幽门螺杆菌)在国内和国际上。爱尔兰对克拉霉素的主要耐药性和对克拉霉素和甲硝唑的双重耐药性很高。这些趋势要求对最佳做法管理策略进行评估。
目的：本研究的目的是修订爱尔兰医疗机构中成人患者幽门螺杆菌感染管理的建议。
方法：爱尔兰幽门螺杆菌工作组（IHPWG）于2016年成立，并于2023年重新召集，以评估有关幽门螺杆菌诊断的最新文献，根除率和抗菌素耐药性。然后使用“等级”方法对可用证据的质量进行评级，并对所得建议进行评级。
结果：爱尔兰幽门螺杆菌工作组就14项共识声明达成一致。主要建议包括：（1）不再推荐用于指导治疗的常规抗菌药物敏感性试验，除了一线治疗的克拉霉素敏感性试验（声明6和9），（2）克拉霉素三联疗法仅在克拉霉素敏感性已被确认的情况下才应作为一线疗法（声明9），（3）铋四联疗法（质子泵抑制剂，铋,甲硝唑,四环素）是推荐的一线治疗，如果克拉霉素耐药性未知或证实（声明10），（4）质子泵抑制剂铋四联疗法，左氧氟沙星和阿莫西林是推荐的二线治疗(声明11)和(5)利福布汀阿莫西林三联疗法是推荐的抢救疗法(声明12).
结论：这些建议旨在为爱尔兰成人幽门螺杆菌感染的管理提供最相关的当前最佳实践指南。
目的：本研究的目的是修订爱尔兰医疗机构中成人患者幽门螺杆菌感染管理的建议。
方法：爱尔兰幽门螺杆菌工作组（IHPWG）于2016年成立，并于2023年重新召集，以评估有关幽门螺杆菌诊断的最新文献，根除率和抗菌素耐药性。然后使用“等级”方法对可用证据的质量进行评级，并对所得建议进行评级。
结果：爱尔兰幽门螺杆菌工作组就14项共识声明达成一致。主要建议包括：（1）不再推荐用于指导治疗的常规抗菌药物敏感性试验，除了一线治疗的克拉霉素敏感性试验（声明6和9），（2）克拉霉素三联疗法仅在克拉霉素敏感性已被确认的情况下才应作为一线疗法（声明9），（3）铋四联疗法（质子泵抑制剂，铋,甲硝唑,四环素）是推荐的一线治疗，如果克拉霉素耐药性未知或证实（声明10），（4）质子泵抑制剂铋四联疗法，左氧氟沙星和阿莫西林是推荐的二线治疗(声明11)和(5)利福布汀阿莫西林三联疗法是推荐的抢救疗法(声明12).
结论：这些建议旨在为爱尔兰成人幽门螺杆菌感染的管理提供最相关的当前最佳实践指南。
