Zusammenfassung
Zunehmende Resistenzen gegen die regelmäßig verwendeten Antibiotika Clarithromycin und Metronidazol haben zu sinkenden Eradikationsraten in der Standard-Erstlinientherapie der Helicobacter-pylori-Infektion geführt. Dies erfordert die Evaluation neuer Substanzen und Therapieschemata, um alternative Therapiestrategien anbieten zu können. Fluorchinonolone haben ein breites Wirkspektrum gegen Gram-positive und Gram-negative Erreger und sind dabei gut verträglich. In der Zweitlinientherapie der Eradikation von Helicobacter pylori sind Fluorchinolone aufgrund von vielen Studienergebnissen mittlerweile anerkannt und werden in aktuellen Leitlinien empfohlen. In den letzten Jahren wurden auch Fluorchinolon-haltige Schemata mit Levofloxacin und Moxifloxacin in der Erstlinientherapie der H.-pylori-Infektion intensiv untersucht. Allerdings müssen vor dem Hintergrund bereits steigender Resistenzraten von Helicobacter pylori gegen Fluorchinolone Vor- und Nachteile dieser Substanzen kritisch abgewogen werden. Erste präklinische und klinische Erfahrungen liegen bereits zu dem neuen Fluorchinolon Sitafloxacin vor, das möglicherweise eine Resistenz gegen herkömmliche Fluorchinolone überwinden kann. Diese Arbeit gibt einen aktuellen Überblick über den gesicherten Stellenwert der Fluorchinolone sowie über mögliche zukünftige Indikationen in der H.-pylori-Therapie.
Abstract
Eradication rates in first-line Helicobacter pylori therapy have been declining over the last decades, mainly due to increasing resistance against the recommended antibiotics clarithromycin and metronidazole. Thus, there is a need to evaluate novel regimens and substances to offer effective alternative treatment strategies. New generation quinolones, like levofloxacin and moxifloxacin, exhibit a broad-spectrum activity against various Gram-positive and Gram-negative strains and are mostly well tolerated. Based on a large number of studies, quinolones have been introduced in second-line and rescue treatment and are recommended for these indications in current guidelines. Various studies have investigated alternative strategies for first-line treatment including quinolone-based regimens. In the context of increasing resistance rates of Helicobacter pylori against quinolones some risks and benefits have to be considered when using quinolones as a first-line strategy. Besides numerous studies investigating levofloxacin and moxifloxacin there are some promising results for the new substance sitafloxacin, which might overcome primary resistance of Helicobacter pylori against conventional quinolones.
Schlüsselwörter
Erstlinientherapie - Helicobacter pylori - Levofloxacin - Moxifloxacin - Sitafloxacin - Fluorchinolon-Resistenz
Key words
first-line therapy - Helicobacter pylori - levofloxacin - moxifloxacin - sitafloxacin - quinolone-resistance
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Prof. Dr. Stephan Miehlke
Magen-Darm-Zentrum, Internistische Kooperation Eppendorf
Eppendorfer Landstr. 42
20249 Hamburg
Phone: ++ 49/4 04 60 20 01
Fax: ++ 49/40 47 35 47
Email: prof.miehlke@mdz-hamburg.de
