Shu Sahara, Mitsushige Sugimoto, Masaki Murata, Eri Iwata, Takashi Kawai, Kazunari Murakami, Yoshio Yamaoka, Tadashi Shimoyama
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Although previous studies have investigated the benefits of eradication therapy for patients receiving HD, because most studies were small in terms of the number of enrolled patients, it is hard to show evidence. The numbers of eradication in HD patients have recently increased, and it is important to provide an optimal regimen. The consideration of eradication in patients undergoing HD with a reduction in the drug dose by 1/2–1/3 may prevent adverse events. Additionally, another important consideration is whether adverse events can be prevented while maintaining a similar eradication rate with reduced drug dosages. Recent meta-analysis findings indicate comparable eradication rates in patients receiving HD and healthy individuals, both with the same dosage regimen and at a reduced dosage regimen, with no significant differences (relative risk [RR] for successful eradication: 0.85 [95% confidence interval (CI): 0.48–1.50]). Unlike with the same dosage regimen (RR for adverse events: 3.15 [95% CI: 1.93–5.13]), the adverse events in the dosage reduction regimen were similar to those in healthy individuals (RR: 1.26 [95% CI: 0.23–6.99]). 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引用次数: 0
摘要
接受血液透析(HD)的患者经常会患上胃肠道疾病。最近,尽管在普通人群中,幽门螺杆菌临床指南强烈建议患者根除幽门螺杆菌以预防胃癌,但由于可能发生的不良反应,接受血液透析患者的最佳根除方案和最佳用药剂量尚未确定。根除疗法中使用的一些抗菌药物,尤其是阿莫西林,会加重肾功能障碍。与健康人相比,接受血液透析患者的药物代谢动力学会有所延迟,因此应考虑药物治疗方案和剂量,以尽量减少不良反应。尽管之前的研究已经调查了根除疗法对接受血液透析患者的益处,但由于大多数研究的入选患者人数较少,因此很难拿出证据。最近,对 HD 患者进行根除治疗的人数有所增加,因此提供最佳治疗方案非常重要。在考虑对接受 HD 的患者进行根除治疗的同时,将药物剂量减少 1/2-1/3 可能会避免不良事件的发生。此外,另一个重要的考虑因素是,在减少药物剂量的情况下,能否在保持类似根除率的同时预防不良事件的发生。最近的荟萃分析结果表明,接受 HD 治疗的患者和健康人的根除率相当,无论是使用相同剂量方案还是减少剂量方案,都没有显著差异(成功根除的相对风险 [RR]:0.85 [95% 置信区间]):0.85 [95% 置信区间 (CI):0.48-1.50])。与相同剂量方案不同(不良反应 RR:3.15 [95% CI:1.93-5.13]),减量方案的不良反应与健康人相似(RR:1.26 [95% CI:0.23-6.99])。从药理学角度来看,接受 HD 治疗的患者的根除方案应考虑剂量(1/2-1/3 剂量)、给药次数(bid)、给药时间(HD 后)以及对抗菌药物的敏感性。
Eradication Therapy for Helicobacter pylori Infection in Patients Receiving Hemodialysis: Review
Patients receiving hemodialysis (HD) often develop gastrointestinal diseases. Recently, although in general population, clinical guidelines for Helicobacter pylori have strongly recommended its eradication in patients to prevent gastric cancer, optimal eradication regimen and optimal dosage of drugs for patients receiving HD have not been established, due to possible incidence of adverse events. Some antimicrobial agents used in eradication therapy, particularly amoxicillin, can exacerbate renal dysfunction. Given the delayed pharmacokinetics of drugs in patients receiving HD compared with those in healthy individuals, drug regimen and dosage should be considered to minimize adverse effects. Although previous studies have investigated the benefits of eradication therapy for patients receiving HD, because most studies were small in terms of the number of enrolled patients, it is hard to show evidence. The numbers of eradication in HD patients have recently increased, and it is important to provide an optimal regimen. The consideration of eradication in patients undergoing HD with a reduction in the drug dose by 1/2–1/3 may prevent adverse events. Additionally, another important consideration is whether adverse events can be prevented while maintaining a similar eradication rate with reduced drug dosages. Recent meta-analysis findings indicate comparable eradication rates in patients receiving HD and healthy individuals, both with the same dosage regimen and at a reduced dosage regimen, with no significant differences (relative risk [RR] for successful eradication: 0.85 [95% confidence interval (CI): 0.48–1.50]). Unlike with the same dosage regimen (RR for adverse events: 3.15 [95% CI: 1.93–5.13]), the adverse events in the dosage reduction regimen were similar to those in healthy individuals (RR: 1.26 [95% CI: 0.23–6.99]). From a pharmacological perspective, the eradication regimen in patients receiving HD should consider the dosage (1/2–1/3 dosage), dosing number (bid), dosing timing of drugs (after HD), and susceptibility to antimicrobial agents.
期刊介绍:
Helicobacter is edited by Professor David Y Graham. The editorial and peer review process is an independent process. Whenever there is a conflict of interest, the editor and editorial board will declare their interests and affiliations. Helicobacter recognises the critical role that has been established for Helicobacter pylori in peptic ulcer, gastric adenocarcinoma, and primary gastric lymphoma. As new helicobacter species are now regularly being discovered, Helicobacter covers the entire range of helicobacter research, increasing communication among the fields of gastroenterology; microbiology; vaccine development; laboratory animal science.