헬리코박터 파일로리 제균을 위한 치료 기간은 7일, 10일, 14일 다양합니다. UpToDate는 헬리코박터 파일로리 제균을 위해 14일 동안 clarithromycin-based triple therapy와 bismuth quadruple treatment regimens을 권고합니다. 이 권고는 헬리코박터 파일로리에 대한 모든 항생제 치료에 연장된 치료(10 일에서 14 일) 치료를 권고하는 현행 지침과 크게 일치합니다.
First-line therapies for H. pylori infection
|
Regimen |
Drugs (doses) |
Dosing frequency |
Duration (days) |
FDA approval |
|
Clarithromycin triple‡ |
PPI (standard* or double dose) |
Twice daily |
14 |
Yes¶ |
|
Clarithromycin (500 mg) |
Twice daily |
|||
|
Amoxicillin (1 gram) or Metronidazole (500 mg) |
Twice daily (amoxicillin) Three times daily (metronidazole) |
|||
|
Bismuth quadruple |
PPI (standard dose*) |
Twice daily |
10 to 14Δ |
No◊ |
|
Bismuth subcitrate (120 to 300 mg [not available in US] or 420 mg [available in North America and elsewhere as part of Pylera combination pill])[1] or Bismuth subsalicylate (300 or 524 mg)[1] |
Four times daily |
|||
|
Tetracycline (500 mg) |
Four times daily |
|||
|
Metronidazole (250 to 500 mg) |
Four times daily (250 mg) |
|||
|
Three to four times daily (500 mg) |
||||
|
Clarithromycin-based concomitant‡ |
PPI (standard dose*) |
Twice daily |
10 to 14 |
No |
|
Clarithromycin (500 mg) |
Twice daily |
|||
|
Amoxicillin (1 gram) |
Twice daily |
|||
|
Metronidazole or tinidazole (500 mg) |
Twice daily |
|||
|
Clarithromycin-based sequential§‡ |
PPI (standard dose*) plus amoxicillin (1 gram) for 5 days followed by: |
Twice daily |
10 (total) |
No |
|
PPI, clarithromycin (500 mg) plus either metronidazole or tinidazole (500 mg) for an additional 5 days |
Twice daily |
|||
|
Clarithromycin-based hybrid¥‡ |
PPI (standard dose*) plus amoxicillin (1 gram) for 7 days followed by: |
Twice daily |
14 (total) |
No |
|
PPI, amoxicillin, clarithromycin (500 mg), plus either metronidazole or tinidazole (500 mg) for an additional 7 days |
Twice daily |
FDA: United States Food and Drug Administration; PPI: proton pump inhibitor.
* Standard dosing of orally administered proton pump inhibitors include: Lansoprazole 30 mg twice daily, omeprazole 20 mg twice daily, pantoprazole 40 mg twice daily, rabeprazole 20 mg twice daily, or esomeprazole 20 mg twice daily or 40 mg once daily.
¶ Several PPI, clarithromycin, and amoxicillin combinations have achieved FDA approval. PPI, clarithromycin, and metronidazole is not an FDA-approved treatment regimen.
Δ 14 days is recommended. Refer to UpToDate topic on treatment for H. pylori infection.
◊ PPI, bismuth, tetracycline, and metronidazole prescribed separately is not an FDA-approved treatment regimen. However, Pylera, a combination product containing bismuth subcitrate, tetracycline, and metronidazole combined with a PPI for 10 days is an FDA-approved treatment regimen.
§ Some North American guidelines do not support the use of sequential therapy.
¥ Hybrid therapy has not been universally endorsed as an option for first-line therapy.
‡ In patients with risk factors for macrolide resistance, clarithromycin-based therapy should be avoided.
Reference:
Fallone CA, Chiba N, Van Zanteri et al. The Toronto Consensus for Treatment of Helicobacter pylori infection in Adults. Gastro 2016; 15:51.
Adapted by permission from Macmillan Publishers Ltd: American Journal of Gastroenterology. Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol 2017; 112:212. Copyright © 2017. www.nature.com/ajg.
REF. UpToDate 2019.04.28
