Macrolide 저항성 위험 요인이 있는 환자(예, 어떤 이유로 macrolide 노출 병력, 지역 클래리스로마이신 내성률 15 % 이상)에서는 bismuth quadruple therapy를 사용합니다.
Initial approach to antibiotic treatment for Helicobacter pylori infection
Bismuth quadruple therapy consists of bismuth, metronidazole, tetracycline, and a PPI.
Clarithromycin based triple therapy with amoxicillin consists of clarithromycin, amoxicillin, and a PPI.
Clarithromycin based triple therapy with metronidazole consists of clarithromycin, metronidazole, and a PPI.
* In the United States, given the limited information on antimicrobial resistance rates, we generally assume clarithromycin resistance rates are ≥15% unless local data indicate otherwise.
¶ Alternative first-line antibiotic regimens include bismuth quadruple therapy and clarithromycin based concomitant therapy. Other potential treatment regimens include clarithromycin based sequential or hybrid therapy. However, hybrid therapy has not been universally endorsed as an option for first-line therapy and some North American guidelines do not support the use of sequential therapy. Refer to UpToDate topic on treatment regimens for H. pylori for additional details.
|
Bismuth quadruple |
PPI (standard dose) |
Twice daily |
10 to 14 |
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]) or Bismuth subsalicylate (300 or 524 mg) |
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) |
REF. UpToDate 2019.04.28
