Zusammenfassung
Helicobacter pylori ist ein zentraler Faktor in der Pathogenese
vieler Magenerkrankungen und eine Eradikation hat in vielen klinischen
Situationen einen therapeutischen oder prophylaktischen Effekt.
Die Behandlung der Helicobacterinfektion kann jedoch ein klinisches
Problem darstellen und die weithin empfohlene Clarithromycin-basierte
Triple-Therapie ist für mehr als 20 % der
Patienten wirkungslos. Gründe für ein Therapieversagen
sind insbesondere bakterielle Antibiotikaresistenzen aber auch eine
Bakterienpersistenz im saurem Magenmilieu, beispielsweise bei schneller
Metabolisierung von Protonenpumpeninhibitoren. Bessere Therapieeffekte können
zum einen durch eine für Patient und Pathogen individualisierte
Behandlung erreicht werden. Ein anderer Ansatz zur Therapieverbesserung
ist die Intensivierung der Antibiotikabehandlung als sogenannte
sequentielle oder konkomitante Therapien. Diese und weitere erst
in einzelnen Studien getestete Behandlungsstrategien erreichen Effizienzen
von 90 % bis über 95 % und
sollten vermehrt in die klinische Praxis Eingang finden.
Abstract
Helicobacter plays a central role in the pathogenesis of several
gastric diseases and its eradication has a therapeutic or prophylactic
effect in many clinical situations. However, treatment of Helicobacter
infection can be challenging and the frequently recommended clarithromycin based
triple therapy fails in more than 20% of patients. Reasons for
treatment failure include antibiotic resistances and bacterial persistence
in an acidic stomach, for instance due to rapid metabolization of
the proton pump inhibitor by the host. Therapeutic efficiency can
be improved by a therapy tailored for an individual patient and
the respective pathogen. In an alternative approach the antibiotic
therapy can be intensified leading to a sequential or concomitant
therapy. These and other strategies tested only in single studies
can achieve eradication in 90 % and up to over
95 % of patients, respectively, and should be
used more often in clinical practice.
Schlüsselwörter
Helicobacter pylori - Eradikation - Antibiotikaresistenz - Triple-Therapie - bakterielle Persistenz - individualisierte Therapie - sequentielle Therapie - konkomitante Therapie
Keywords
helicobacter pylori - eradication - antibiotic resistance - triple therapy - bacterial persistence - tailored therapy - sequential therapy - concomitant therapy
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Dr. med. Benjamin Misselwitz
Klinik für Gastroenterologie
UniversitätsSpital
Zürich
Rämistr. 100
CH-8091
Zürich
Email: Benjamin.Misselwitz@usz.ch
