Neue Möglichkeiten der Helicobacter-pylori-Behandlung mit Antibiotika

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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