علاج عدوى الملوية البوابية (H. pylori) شديد التخصيص، مع توفر العديد من البرامج العلاجية الفعالة. يعتمد اختيار العلاج بشكل كبير على أنماط المقاومة المحلية للمضادات الحيوية، والتاريخ الدوائي للمريض، وأي حساسيات دوائية. يوضح هذا الدليل الشامل جميع خيارات العلاج الرئيسية - من العلاجات الخط الأول إلى علاجات الإنقاذ - بما في ذلك جرعات الأدوية المحددة، ومدة العلاج، ومعدلات النجاح الموثقة، مما يمكن المرضى من إجراء مناقشات مستنيرة مع مقدمي الرعاية الصحية.

دليل المريض لخيارات علاج عدوى الملوية البوابية

جدول المحتويات

• المقدمة: لماذا العلاج مُخصَّص
• خيارات العلاج في الخط الأول
• العلاجات في الخط الثاني وعلاجات الإنقاذ
• العلاجات المساعدة والتجريبية
• النقاط الرئيسية والخطوات التالية
• معلومات المصدر

المقدمة: لماذا العلاج مُخصَّص

علاج عدوى الملوية البوابية (H. pylori) ليس نهجًا واحدًا يناسب الجميع. هذه البكتيريا، التي يمكن أن تسبب قرح المعدة ومشاكل هضمية أخرى، طورت مستويات متفاوتة من المقاومة للمضادات الحيوية المختلفة حول العالم. بسبب هذا، سيختار طبيبك نظام العلاج الأولي تجريبيًا. هذا يعني أن الاختيار يعتمد على العلاجات الأكثر فعالية في منطقتك الجغرافية المحددة، والمبادئ التوجيهية الطبية المحلية، والأدوية المتاحة بسهولة.

لقد تطور مجال علاج الملوية البوابية بشكل كبير. يطبق الأطباء الآن بقوة مبادئ الإشراف على المضادات الميكروبية، مما يعني اختيار المضادات الحيوية بعناية للحفاظ على فعاليتها ومنع مزيد من المقاومة. كما زادت توفر اختبارات الحساسية، حيث يمكن اختبار عينة من معدتك لمعرفة أي المضادات الحيوية ستعمل بشكل أفضل ضد العدوى المحددة لديك.

تاريخك الطبي حاسم. سيسألك طبيبك أسئلة مفصلة حول أي استخدام سابق للمضادات الحيوية، حيث يجب مراعاة هذا التاريخ لتجنب اختيار علاج قد تكون البكتيريا مقامة له بالفعل. تشمل الخيارات الأولية الشائعة العلاج الرباعي القائم على البزموت لمدة 14 يومًا أو العلاج الثلاثي القائم على الريفابوتين، ولكن الخيار الأفضل دائمًا هو النظام الذي ثبتت فعاليته العالية في منطقتك المحلية.

خيارات العلاج في الخط الأول

هناك عدة فئات من علاجات الخط الأول، لكل منها تركيبات دوائية محددة، ومدة علاج، ومعدلات نجاح.

العلاج الثلاثي

يظل العلاج الثلاثي القائم على مثبط مضخة البروتون (PPI) خيارًا في الخط الأول في المناطق التي تكون فيها مقاومة الكلاريثروميسين منخفضة (أقل من 15٪). يتكون هذا النظام من ثلاثة مكونات تؤخذ لمدة 14 يومًا:

• مثبط مضخة البروتون (PPI) لتقليل حمض المعدة. أمثلة تشمل:
  • أوميبرازول 20 مجم مرتين يوميًا (BID)
  • لانسوبرازول 30 مجم مرتين يوميًا (BID)
  • إيسوميبرازول 40 مجم مرة يوميًا (QD)
  • بانتوبرازول 40 مجم مرة يوميًا (QD)
  • رابيبرازول 20 مجم مرتين يوميًا (BID)
• كلاريثروميسين 500 مجم مرتين يوميًا (BID) (إذا لم يكن هناك تعرض سابق للماكروليد ومقاومة محلية منخفضة) أو ميترونيدازول 500 مجم مرتين يوميًا (BID) (إذا كانت مقاومة الكلاريثروميسين مصدر قلق)
• أموكسيسيلين 1000 مجم مرتين يوميًا (BID) أو، إذا لم يتم اختياره بالفعل، ميترونيدازول 500 مجم مرتين يوميًا (BID)

بعض هذه الأدوية متاحة في تركيبات معبأة مسبقًا مريحة مثل Omeclamox-Pak و Prevpac. خلص تحليل رئيسي لـ 55 دراسة إلى أن مدة 14 يومًا هي الأمثل، حيث تحقق معدل استئصال يبلغ 81.9٪، مقارنة بـ 72.9٪ فقط لدورة مدتها 7 أيام.

العلاج القائم على الريفابوتين (Talicia)

هذا نظام علاج ثلاثي لمدة 14 يومًا حيث تؤخذ ثلاثة أدوية معًا كل 8 ساعات:

• أموكسيسيلين 1 جم
• أوميبرازول 40 مجم
• ريفابوتين 50 مجم

هذا معبأ مسبقًا كـ Talicia، والذي تمت الموافقة عليه من قبل إدارة الغذاء والدواء الأمريكية (FDA) في عام 2019 بناءً على دراستين أظهرتا معدلات استئصال بلغت 84.1٪ و 90.3٪. غالبًا ما يوصى به كعلاج إنقاذ إذا فشلت أدوية الخط الأول.

العلاج القائم على الفونوبرازان (Voquezna)

في مايو 2022، وافقت إدارة الغذاء والدواء الأمريكية (FDA) على أول علاج قائم على حاصض مضخة البوتاسيوم (PCAB)، وهو علاج ثلاثي لمدة 14 يومًا مع:

• فونوبرازان 20 مجم مرتين يوميًا (BID)
• أموكسيسيلين 1000 مجم مرتين يوميًا (BID)
• كلاريثروميسين 500 مجم مرتين يوميًا (BID)

تم تعبئته كـ Voquezna Triple Pak. كما تمت الموافقة على العلاج المزدوج (فونوبرازان بالإضافة إلى أموكسيسيلين). ومع ذلك، لم يتم إطلاق أي من المنتجين إلى السوق بسبب اكتشاف مستويات ضئيلة من شوائب النيتروسامين أثناء التصنيع.

العلاجات الرباعية غير المحتوية على البزموت

تتضمن هذه الأنظمة أربعة أدوية ويمكن إعطاؤها بتسلسلات مختلفة.

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