DGI:Helicobacter Pylori/Therapie: Difference between revisions
imported>Brinkery (Die Seite wurde neu angelegt: „== Therapie ==“) |
imported>Brinkery No edit summary |
||
| Line 1: | Line 1: | ||
== Therapie == | ==Therapie== | ||
'''Indikation zur Behandlung''' | |||
* Bei peptischen Ulcus ventriculi oder Ulcus duodeni | |||
* Bei gastralen MALT-Lymphomen | |||
* Bei diffus-großzelligen B-Zell-Lymphom des Magens | |||
* B-Gastritis zur Karzinomprophylaxe, insbesondere bei positiver Familienanamnese | |||
* Bei Nachweis von Adenomen oder hyperplastischen Magenpolypen | |||
* Bei Patienten mit einer ITP, Morbus Menier oder einer lymphozytären Gastritis | |||
* Vor Antikoagulation bzw. Dauermedikation mit ASS oder NSAR bei gleichzeitiger Ulcusanamnese | |||
'''Behandlung kann angeboten werden''' | |||
* Bei Patienten mit asympt. Hp-Gastritis | |||
* Bei SSRI-Komedikation | |||
* Bei anderen extragastralen Manifestationen | |||
* Bei Hp-Gastritis und Eisenmangelanämie | |||
'''Zurückhaltende/ keine Indikation''' | |||
* Dyspepsie | |||
* Refluxsymptome oder eine Refluxösophagitis | |||
* Bei ungeklärter Eisenmangelanämie | |||
===== Antibiotikatherapien ===== | |||
{| class="wikitable sortable mw-collapsible docData;DOCY;v5;12702;BQiAAgAAEYQCAAAGiAIAAAPrKAAABfkoAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAXyYAAAP3JQAAADIAAAAECQAAAAABAAIEAAAAAAUAAAAABgAAAAAMAQAAAAIJBAAAAKAEAAAKBgAAADUAMgAzAAESAAAADQRpCQAADQSYFQAADQSKBQAAA6QlAAAEugEAAAQAAAAABbABAAAGoAAAAAcbAAAAAgYAAAAAAwYJAAAAAAEBAgRpCQAACwEADQEACHsAAAAAdgAAAAEYAAAAAQYAAAAACQYAAAAAGgYAAAAAGwYAAAAAAlQAAAAFMQAAAAEAAAAACCcAAAAAIgAAAEUAcgBzAHQAcgBhAG4AZwB0AGgAZQByAGEAcABpAGUAbgAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAGeQAAAAcbAAAAAgYAAAAAAwYJAAAAAAEBAgSYFQAACwEADQEACFQAAAAATwAAAAEYAAAAAQYAAAAACQYAAAAAGgYAAAAAGwYAAAAAAi0AAAAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAGiAAAAAcbAAAAAgYAAAAAAwYJAAAAAAEBAgSKBQAACwEADQEACGMAAAAAXgAAAAEYAAAAAQYAAAAACQYAAAAAGgYAAAAAGwYAAAAAAjwAAAAFGQAAAAEAAAAACA8AAAAACgAAAEQAYQB1AGUAcgAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAENwMAAAQAAAAABS0DAAAGrgAAAAcbAAAAAgYAAAAAAwYJAAAAAAEBAgRpCQAACwEADQEACIkAAAAAhAAAAAEYAAAAAQYAAAAACQYAAAAAGgYAAAAAGwYAAAAAAmIAAAAFPwAAAAEAAAAACDUAAAAAMAAAAEIAaQBzAG0AdQB0AGgALQBRAHUAZAByAHUAcABlAGwAdABoAGUAcgBhAHAAaQBlAAUKAAAAAQAAAAAIAAAAAAUKAAAAAQAAAAAIAAAAAAbkAQAABxsAAAACBgAAAAADBgkAAAAAAQECBJgVAAALAQANAQAIvwEAAACMAAAAARgAAAABBgAAAAAJBgAAAAAaBgAAAAAbBgAAAAACagAAAAVHAAAAAQAAAAAIPQAAAAA4AAAAUABQAEkAIAAyACAAeAAgAHQAZwBsAC4AIAAxACAAUwB0AGEAbgBkAGEAcgBkAGQAbwBzAGkAcwAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAArgAAAAEYAAAAAQYAAAAACQYAAAAAGgYAAAAAGwYAAAAAAowAAAAFaQAAAAEAAAAACF8AAAAAWgAAAEIAaQBzAG0AdQB0AGgALQBLAGEAbABpAHUAbQBzAGEAbAB6AC8AIABUAGUAdAByAGEAYwB5AGMAbABpAG4ALwAgAE0AZQB0AHIAbwBuAGkAZABhAHoAbwBsAAUKAAAAAQAAAAAIAAAAAAUKAAAAAQAAAAAIAAAAAAB2AAAAARgAAAABBgAAAAAJBgAAAAAaBgAAAAAbBgAAAAACVAAAAAUxAAAAAQAAAAAIJwAAAAAiAAAANAAgAHgAIAAzACAASABhAHIAdABrAGEAcABzAGUAbABuAAUKAAAAAQAAAAAIAAAAAAUKAAAAAQAAAAAIAAAAAAaMAAAABxsAAAACBgAAAAADBgkAAAAAAQECBIoFAAALAQANAQAIZwAAAABiAAAAARgAAAABBgAAAAAJBgAAAAAaBgAAAAAbBgAAAAACQAAAAAUdAAAAAQAAAAAIEwAAAAAOAAAAMQAwACAAVABhAGcAZQAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAEKwMAAAQAAAAABSEDAAAGtAAAAAcbAAAAAgYAAAAAAwYJAAAAAAEBAgRpCQAACwEADQEACI8AAAAAigAAAAEYAAAAAQYAAAAACQYAAAAAGgYAAAAAGwYAAAAAAmgAAAAFRQAAAAEAAAAACDsAAAAANgAAAEYAcgBhAG4AegD2AHMAaQBzAGMAaABlACAAVAByAGkAcABlAGwAdABoAGUAcgBhAHAAaQBlAAUKAAAAAQAAAAAIAAAAAAUKAAAAAQAAAAAIAAAAAAbMAQAABxsAAAACBgAAAAADBgkAAAAAAQECBJgVAAALAQANAQAIpwEAAACMAAAAARgAAAABBgAAAAAJBgAAAAAaBgAAAAAbBgAAAAACagAAAAVHAAAAAQAAAAAIPQAAAAA4AAAAUABQAEkAIAAyACAAeAAgAHQAZwBsAC4AIAAxACAAUwB0AGEAbgBkAGEAcgBkAGQAbwBzAGkAcwAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAAhgAAAAEYAAAAAQYAAAAACQYAAAAAGgYAAAAAGwYAAAAAAmQAAAAFQQAAAAEAAAAACDcAAAAAMgAAAEEAbQBvAHgAaQBjAGkAbABsAGkAbgAgADIALQAzACAAeAAgADEAMAAwADAAIABtAGcABQoAAAABAAAAAAgAAAAABQoAAAABAAAAAAgAAAAAAIYAAAABGAAAAAEGAAAAAAkGAAAAABoGAAAAABsGAAAAAAJkAAAABUEAAAABAAAAAAg3AAAAADIAAABDAGwAYQByAGkAdABoAHIAbwBtAHkAYwBpAG4AIAAyACAAeAAgADUAMAAwACAAbQBnAAUKAAAAAQAAAAAIAAAAAAUKAAAAAQAAAAAIAAAAAAaSAAAABxsAAAACBgAAAAADBgkAAAAAAQECBIoFAAALAQANAQAIbQAAAABoAAAAARgAAAABBgAAAAAJBgAAAAAaBgAAAAAbBgAAAAACRgAAAAUjAAAAAQAAAAAIGQAAAAAUAAAAMQAwAC0AMQA0ACAAVABhAGcAZQAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAEJwMAAAQAAAAABR0DAAAGtAAAAAcbAAAAAgYAAAAAAwYJAAAAAAEBAgRpCQAACwEADQEACI8AAAAAigAAAAEYAAAAAQYAAAAACQYAAAAAGgYAAAAAGwYAAAAAAmgAAAAFRQAAAAEAAAAACDsAAAAANgAAAEkAdABhAGwAaQBlAG4AaQBzAGMAaABlACAAVAByAGkAcABlAGwAdABoAGUAcgBhAHAAaQBlAAUKAAAAAQAAAAAIAAAAAAUKAAAAAQAAAAAIAAAAAAbIAQAABxsAAAACBgAAAAADBgkAAAAAAQECBJgVAAALAQANAQAIowEAAACMAAAAARgAAAABBgAAAAAJBgAAAAAaBgAAAAAbBgAAAAACagAAAAVHAAAAAQAAAAAIPQAAAAA4AAAAUABQAEkAIAAyACAAeAAgAHQAZwBsAC4AIAAxACAAUwB0AGEAbgBkAGEAcgBkAGQAbwBzAGkAcwAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAAggAAAAEYAAAAAQYAAAAACQYAAAAAGgYAAAAAGwYAAAAAAmAAAAAFPQAAAAEAAAAACDMAAAAALgAAAE0AZQB0AHIAbwBuAGkAZABhAHoAbwBsACAAMgAgAHgAIAA0ADAAMAAgAG0AZwAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAAhgAAAAEYAAAAAQYAAAAACQYAAAAAGgYAAAAAGwYAAAAAAmQAAAAFQQAAAAEAAAAACDcAAAAAMgAAAEMAbABhAHIAaQB0AGgAcgBvAG0AeQBjAGkAbgAgADIAIAB4ACAANQAwADAAIABtAGcABQoAAAABAAAAAAgAAAAABQoAAAABAAAAAAgAAAAABpIAAAAHGwAAAAIGAAAAAAMGCQAAAAABAQIEigUAAAsBAA0BAAhtAAAAAGgAAAABGAAAAAEGAAAAAAkGAAAAABoGAAAAABsGAAAAAAJGAAAABSMAAAABAAAAAAgZAAAAABQAAAAxADAALQAxADQAIABUAGEAZwBlAAUKAAAAAQAAAAAIAAAAAAUKAAAAAQAAAAAIAAAAAARxBAAABAAAAAAFZwQAAAZ3AQAABxsAAAACBgAAAAADBgkAAAAAAQECBGkJAAALAQANAQAIUgEAAACWAAAAARgAAAABBgAAAAAJBgAAAAAaBgAAAAAbBgAAAAACdAAAAAVRAAAAAQAAAAAIRwAAAABCAAAASwBvAG0AawBvAG0AaQB0AHQAaQBlAHIAZQBuAGQAZQAgAFYAaQBlAHIAZgBhAGMAaAB0AGgAZQByAGEAcABpAGUABQoAAAABAAAAAAgAAAAABQoAAAABAAAAAAgAAAAAALIAAAABGAAAAAEGAAAAAAkGAAAAABoGAAAAABsGAAAAAAKQAAAABW0AAAABAAAAAAhjAAAAAF4AAABTAG8AbABsAHQAZQBuACAAdwBpAHIAIABlAHYAdABsAC4AIABuAGkAYwBoAHQAIABoAGkAbgBlAGkAbgBuAGUAaABtAGUAbgAgAC0AIABNAC4AIABPAGUAdAB0AGUABQoAAAABAAAAAAgAAAAABQoAAAABAAAAAAgAAAAABk8CAAAHGwAAAAIGAAAAAAMGCQAAAAABAQIEmBUAAAsBAA0BAAgqAgAAAIwAAAABGAAAAAEGAAAAAAkGAAAAABoGAAAAABsGAAAAAAJqAAAABUcAAAABAAAAAAg9AAAAADgAAABQAFAASQAgADIAIAB4ACAAdABnAGwALgAgADEAIABTAHQAYQBuAGQAYQByAGQAZABvAHMAaQBzAAUKAAAAAQAAAAAIAAAAAAUKAAAAAQAAAAAIAAAAAACCAAAAARgAAAABBgAAAAAJBgAAAAAaBgAAAAAbBgAAAAACYAAAAAU9AAAAAQAAAAAIMwAAAAAuAAAAQQBtAG8AeABpAGMAaQBsAGwAaQBuACAAMgAgAHgAIAAxADAAMAAwACAAbQBnAAUKAAAAAQAAAAAIAAAAAAUKAAAAAQAAAAAIAAAAAACGAAAAARgAAAABBgAAAAAJBgAAAAAaBgAAAAAbBgAAAAACZAAAAAVBAAAAAQAAAAAINwAAAAAyAAAAQwBsAGEAcgBpAHQAaAByAG8AbQB5AGMAaQBuACAAMgAgAHgAIAA1ADAAMAAgAG0AZwAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAAggAAAAEYAAAAAQYAAAAACQYAAAAAGgYAAAAAGwYAAAAAAmAAAAAFPQAAAAEAAAAACDMAAAAALgAAAE0AZQB0AHIAbwBuAGkAZABhAHoAbwBsACAAMgAgAHgAIAA0ADAAMAAgAG0AZwAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAGkgAAAAcbAAAAAgYAAAAAAwYJAAAAAAEBAgSKBQAACwEADQEACG0AAAAAaAAAAAEYAAAAAQYAAAAACQYAAAAAGgYAAAAAGwYAAAAAAkYAAAAFIwAAAAEAAAAACBkAAAAAFAAAADEAMAAtADEANAAgAFQAYQBnAGUABQoAAAABAAAAAAgAAAAABQoAAAABAAAAAAgAAAAABIQBAAAEAAAAAAV6AQAABnkAAAAHGwAAAAIGAAAAAAMGCQAAAAABAQIEaQkAAAsBAA0BAAhUAAAAAE8AAAABGAAAAAEGAAAAAAkGAAAAABoGAAAAABsGAAAAAAItAAAABQoAAAABAAAAAAgAAAAABQoAAAABAAAAAAgAAAAABQoAAAABAAAAAAgAAAAABnkAAAAHGwAAAAIGAAAAAAMGCQAAAAABAQIEmBUAAAsBAA0BAAhUAAAAAE8AAAABGAAAAAEGAAAAAAkGAAAAABoGAAAAABsGAAAAAAItAAAABQoAAAABAAAAAAgAAAAABQoAAAABAAAAAAgAAAAABQoAAAABAAAAAAgAAAAABnkAAAAHGwAAAAIGAAAAAAMGCQAAAAABAQIEigUAAAsBAA0BAAhUAAAAAE8AAAABGAAAAAEGAAAAAAkGAAAAABoGAAAAABsGAAAAAAItAAAABQoAAAABAAAAAAgAAAAABQoAAAABAAAAAAgAAAAABQoAAAABAAAAAAgAAAAABLEBAAAEAAAAAAWnAQAABqYAAAAHGwAAAAIGAAAAAAMGCQAAAAABAQIEaQkAAAsBAA0BAAiBAAAAAHwAAAABGAAAAAEGAAAAAAkGAAAAABoGAAAAABsGAAAAAAJaAAAABTcAAAABAAAAAAgtAAAAACgAAABBAGwAdABlAHIAbgBhAHQAaQB2AGUAIABTAGMAaABlAG0AYQB0AGEABQoAAAABAAAAAAgAAAAABQoAAAABAAAAAAgAAAAABnkAAAAHGwAAAAIGAAAAAAMGCQAAAAABAQIEmBUAAAsBAA0BAAhUAAAAAE8AAAABGAAAAAEGAAAAAAkGAAAAABoGAAAAABsGAAAAAAItAAAABQoAAAABAAAAAAgAAAAABQoAAAABAAAAAAgAAAAABQoAAAABAAAAAAgAAAAABnkAAAAHGwAAAAIGAAAAAAMGCQAAAAABAQIEigUAAAsBAA0BAAhUAAAAAE8AAAABGAAAAAEGAAAAAAkGAAAAABoGAAAAABsGAAAAAAItAAAABQoAAAABAAAAAAgAAAAABQoAAAABAAAAAAgAAAAABQoAAAABAAAAAAgAAAAABGkDAAAEAAAAAAVfAwAABroAAAAHGwAAAAIGAAAAAAMGCQAAAAABAQIEaQkAAAsBAA0BAAiVAAAAAJAAAAABGAAAAAEGAAAAAAkGAAAAABoGAAAAABsGAAAAAAJuAAAABUsAAAABAAAAAAhBAAAAADwAAABGAGwAdQBvAHIAYwBoAGkAbgBvAGwAbwBuAC0AVAByAGkAcABlAGwAdABoAGUAcgBhAHAAaQBlACAASQAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAGBAIAAAcbAAAAAgYAAAAAAwYJAAAAAAEBAgSYFQAACwEADQEACN8BAAAAjAAAAAEYAAAAAQYAAAAACQYAAAAAGgYAAAAAGwYAAAAAAmoAAAAFRwAAAAEAAAAACD0AAAAAOAAAAFAAUABJACAAMgAgAHgAIAB0AGcAbAAuACAAMQAgAFMAdABhAG4AZABhAHIAZABkAG8AcwBpAHMABQoAAAABAAAAAAgAAAAABQoAAAABAAAAAAgAAAAAAL4AAAABGAAAAAEGAAAAAAkGAAAAABoGAAAAABsGAAAAAAKcAAAABXkAAAABAAAAAAhvAAAAAGoAAABMAGUAdgBvAGYAbABvAHgAYQBjAGkAbgAgADUAMAAwACAAbQBnACAAbwBkAGUAcgAgAE0AbwB4AGkAZgBsAG8AeABhAGMAaQBuACAANAAwADAAIABtAGcAIAAxACAAeAAgAHQAZwBsAC4ABQoAAAABAAAAAAgAAAAABQoAAAABAAAAAAgAAAAAAIYAAAABGAAAAAEGAAAAAAkGAAAAABoGAAAAABsGAAAAAAJkAAAABUEAAAABAAAAAAg3AAAAADIAAABBAG0AbwB4AGkAYwBpAGwAbABpAG4AIAAyAC0AMwAgAHgAIAAxADAAMAAwACAAbQBnAAUKAAAAAQAAAAAIAAAAAAUKAAAAAQAAAAAIAAAAAAaSAAAABxsAAAACBgAAAAADBgkAAAAAAQECBIoFAAALAQANAQAIbQAAAABoAAAAARgAAAABBgAAAAAJBgAAAAAaBgAAAAAbBgAAAAACRgAAAAUjAAAAAQAAAAAIGQAAAAAUAAAAMQAwAC0AMQA0ACAAVABhAGcAZQAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAEeQMAAAQPAAAABQYJAAAABgEAEwT9AAAABWADAAAGvwAAAAceAAAAAgYAAAAAAwYJAAAAAAEBAgRpCQAABQEBCwEADQEACJcAAAAAkgAAAAEYAAAAAQYAAAAACQYAAAAAGgYAAAAAGwYAAAAAAnAAAAAFTQAAAAEAAAAACEMAAAAAPgAAAEYAbAB1AG8AcgBjAGgAaQBuAG8AbABvAG4ALQBUAHIAaQBwAGUAbAB0AGgAZQByAGEAcABpAGUAIABJAEkABQoAAAABAAAAAAgAAAAABQoAAAABAAAAAAgAAAAABv0BAAAHHgAAAAIGAAAAAAMGCQAAAAABAQIEmBUAAAUBAQsBAA0BAAjVAQAAAIwAAAABGAAAAAEGAAAAAAkGAAAAABoGAAAAABsGAAAAAAJqAAAABUcAAAABAAAAAAg9AAAAADgAAABQAFAASQAgADIAIAB4ACAAdABnAGwALgAgADEAIABTAHQAYQBuAGQAYQByAGQAZABvAHMAaQBzAAUKAAAAAQAAAAAIAAAAAAUKAAAAAQAAAAAIAAAAAAC+AAAAARgAAAABBgAAAAAJBgAAAAAaBgAAAAAbBgAAAAACnAAAAAV5AAAAAQAAAAAIbwAAAABqAAAATABlAHYAbwBmAGwAbwB4AGEAYwBpAG4AIAA1ADAAMAAgAG0AZwAgAG8AZABlAHIAIABNAG8AeABpAGYAbABvAHgAYQBjAGkAbgAgADQAMAAwACAAbQBnACAAMQAgAHgAIAB0AGcAbAAuAAUKAAAAAQAAAAAIAAAAAAUKAAAAAQAAAAAIAAAAAAB8AAAAARgAAAABBgAAAAAJBgAAAAAaBgAAAAAbBgAAAAACWgAAAAU3AAAAAQAAAAAILQAAAAAoAAAAUgBpAGYAYQBiAHUAdABpAG4AIAAyACAAeAAgADEANQAwACAAbQBnAAUKAAAAAQAAAAAIAAAAAAUKAAAAAQAAAAAIAAAAAAaVAAAABx4AAAACBgAAAAADBgkAAAAAAQECBIoFAAAFAQELAQANAQAIbQAAAABoAAAAARgAAAABBgAAAAAJBgAAAAAaBgAAAAAbBgAAAAACRgAAAAUjAAAAAQAAAAAIGQAAAAAUAAAAMQAwAC0AMQA0ACAAVABhAGcAZQAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAEmwQAAAQPAAAABQYJAAAABgEAEwT9AAAABYIEAAAGSgEAAAceAAAAAgYAAAAAAwYJAAAAAAEBAgRpCQAABQEBCwEADQEACCIBAAAAcgAAAAEYAAAAAQYAAAAACQYAAAAAGgYAAAAAGwYAAAAAAlAAAAAFLQAAAAEAAAAACCMAAAAAHgAAAFMAZQBxAHUAZQBuAHoAdABoAGUAcgBhAHAAaQBlAAUKAAAAAQAAAAAIAAAAAAUKAAAAAQAAAAAIAAAAAACmAAAAARgAAAABBgAAAAAJBgAAAAAaBgAAAAAbBgAAAAAChAAAAAVhAAAAAQAAAAAIVwAAAABSAAAAUwBvAGwAbAB0AGUAbgAgAHcAaQByACAAbgBpAGMAaAB0ACAAaABpAG4AZQBpAG4AbgBlAGgAbQBlAG4AIAAtACAATQAuACAATwBlAHQAdABlAAUKAAAAAQAAAAAIAAAAAAUKAAAAAQAAAAAIAAAAAAaaAgAABx4AAAACBgAAAAADBgkAAAAAAQECBJgVAAAFAQELAQANAQAIcgIAAACMAAAAARgAAAABBgAAAAAJBgAAAAAaBgAAAAAbBgAAAAACagAAAAVHAAAAAQAAAAAIPQAAAAA4AAAAUABQAEkAIAAyACAAeAAgAHQAZwBsAC4AIAAxACAAUwB0AGEAbgBkAGEAcgBkAGQAbwBzAGkAcwAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAAmgAAAAEYAAAAAQYAAAAACQYAAAAAGgYAAAAAGwYAAAAAAngAAAAFVQAAAAEAAAAACEsAAAAARgAAAEEAbQBvAHgAaQBjAGkAbABsAGkAbgAgADIALQAzACAAeAAgADEAMAAwADAAIABtAGcAIAAoAFQAYQBnACAAMQAtADUAKQAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAAngAAAAEYAAAAAQYAAAAACQYAAAAAGgYAAAAAGwYAAAAAAnwAAAAFWQAAAAEAAAAACE8AAAAASgAAAEMAbABhAHIAaQB0AGgAcgBvAG0AeQBjAGkAbgAgADIAIAB4ACAANQAwADAAIABtAGcAIAAoAFQAYQBnAGUAIAA2AC0AMQAwACkABQoAAAABAAAAAAgAAAAABQoAAAABAAAAAAgAAAAAAJoAAAABGAAAAAEGAAAAAAkGAAAAABoGAAAAABsGAAAAAAJ4AAAABVUAAAABAAAAAAhLAAAAAEYAAABNAGUAdAByAG8AbgBpAGQAYQB6AG8AbAAgADIAIAB4ACAANAAwADAAIABtAGcAIAAoAFQAYQBnAGUAIAA2AC0AMQAwACkABQoAAAABAAAAAAgAAAAABQoAAAABAAAAAAgAAAAABo8AAAAHHgAAAAIGAAAAAAMGCQAAAAABAQIEigUAAAUBAQsBAA0BAAhnAAAAAGIAAAABGAAAAAEGAAAAAAkGAAAAABoGAAAAABsGAAAAAAJAAAAABR0AAAABAAAAAAgTAAAAAA4AAAAxADAAIABUAGEAZwBlAAUKAAAAAQAAAAAIAAAAAAUKAAAAAQAAAAAIAAAAAAScAQAABA8AAAAFBgkAAAAGAQATBP0AAAAFgwEAAAZ8AAAABx4AAAACBgAAAAADBgkAAAAAAQECBGkJAAAFAQELAQANAQAIVAAAAABPAAAAARgAAAABBgAAAAAJBgAAAAAaBgAAAAAbBgAAAAACLQAAAAUKAAAAAQAAAAAIAAAAAAUKAAAAAQAAAAAIAAAAAAUKAAAAAQAAAAAIAAAAAAZ8AAAABx4AAAACBgAAAAADBgkAAAAAAQECBJgVAAAFAQELAQANAQAIVAAAAABPAAAAARgAAAABBgAAAAAJBgAAAAAaBgAAAAAbBgAAAAACLQAAAAUKAAAAAQAAAAAIAAAAAAUKAAAAAQAAAAAIAAAAAAUKAAAAAQAAAAAIAAAAAAZ8AAAABx4AAAACBgAAAAADBgkAAAAAAQECBIoFAAAFAQELAQANAQAIVAAAAABPAAAAARgAAAABBgAAAAAJBgAAAAAaBgAAAAAbBgAAAAACLQAAAAUKAAAAAQAAAAAIAAAAAAUKAAAAAQAAAAAIAAAAAAUKAAAAAQAAAAAIAAAAAASOAQAABA8AAAAFBgkAAAAGAQATBP0AAAAFdQEAAAbvAAAAByQAAAAABAIAAAACBgAAAAADBgkAAAAAAQECBAEfAAAFAQELAQANAQAIwQAAAAC8AAAAARgAAAABBgAAAAAJBgAAAAAaBgAAAAAbBgAAAAACmgAAAAV3AAAAAQAAAAAIbQAAAABoAAAAxABxAHUAaQB2AGEAbABlAG4AegBkAG8AcwBpAGUAcgB1AG4AZwBlAG4AIABkAGUAcgAgAFAAcgBvAHQAbwBuAGUAbgBwAHUAbQBwAGUAbgBoAGUAbQBtAGUAcgAgACgAUABQAEkAKQAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAGfAAAAAceAAAAAgYAAAAAAwYJAAAAAAEBAgSKBQAABQEBCwEADQEACFQAAAAATwAAAAEYAAAAAQYAAAAACQYAAAAAGgYAAAAAGwYAAAAAAi0AAAAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAE0wMAAAQPAAAABQYJAAAABgEAEwT9AAAABboDAAAGfAAAAAceAAAAAgYAAAAAAwYJAAAAAAEBAgRpCQAABQEBCwEADQEACFQAAAAATwAAAAEYAAAAAQYAAAAACQYAAAAAGgYAAAAAGwYAAAAAAi0AAAAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAGswIAAAceAAAAAgYAAAAAAwYJAAAAAAEBAgSYFQAABQEBCwEADQEACIsCAAAAfgAAAAEYAAAAAQYAAAAACQYAAAAAGgYAAAAAGwYAAAAAAlwAAAAFOQAAAAEAAAAACC8AAAAAKgAAAE8AbQBlAHAAcgBhAHoAbwBsACAAIAAgACAAIAAgACAAMgAwACAAbQBnAAUKAAAAAQAAAAAIAAAAAAUKAAAAAQAAAAAIAAAAAAB6AAAAARgAAAABBgAAAAAJBgAAAAAaBgAAAAAbBgAAAAACWAAAAAU1AAAAAQAAAAAIKwAAAAAmAAAARQBzAG8AbQBlAHAAcgBhAHoAbwBsACAAIAAgADIAMAAgAG0AZwAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAAfgAAAAEYAAAAAQYAAAAACQYAAAAAGgYAAAAAGwYAAAAAAlwAAAAFOQAAAAEAAAAACC8AAAAAKgAAAFAAYQBuAHQAbwBwAHIAYQB6AG8AbAAgACAAIAAgACAANAAwACAAbQBnAAUKAAAAAQAAAAAIAAAAAAUKAAAAAQAAAAAIAAAAAAB+AAAAARgAAAABBgAAAAAJBgAAAAAaBgAAAAAbBgAAAAACXAAAAAU5AAAAAQAAAAAILwAAAAAqAAAATABhAG4AcwBvAHAAcgBhAHoAbwBsACAAIAAgACAAIAAzADAAIABtAGcABQoAAAABAAAAAAgAAAAABQoAAAABAAAAAAgAAAAAAH4AAAABGAAAAAEGAAAAAAkGAAAAABoGAAAAABsGAAAAAAJcAAAABTkAAAABAAAAAAgvAAAAACoAAABSAGEAYgBlAHAAcgBhAHoAbwBsACAAIAAgACAAIAAgADIAMAAgAG0AZwAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAGfAAAAAceAAAAAgYAAAAAAwYJAAAAAAEBAgSKBQAABQEBCwEADQEACFQAAAAATwAAAAEYAAAAAQYAAAAACQYAAAAAGgYAAAAAGwYAAAAAAi0AAAAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAAXgAAAAEnAAAAAQYAAAAACQYPAAAAJwTwAAAACwEBKQQAAAAAGgYAAAAAGwYAAAAAAi0AAAAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAFCgAAAAEAAAAACAAAAAAKAAAAAAAAAAARAAAAAKEIAAAA3AAAAAABAAEGEgAAACQEAAAAACUEAAAAACYEAAAAAAUBAQYBAAcBAAgBAAkGGwAAACcEFAEAAAsBARwBACgEAAAAAB0BACkEyAAAAA4GCAAAAAABAQED////GQEBGwZ9AAAAABQAAAAAAwAAAAUEAAAAAAYEBAAAAAMBAAEUAAAAAAMAAAAFBAAAAAAGBAQAAAADAQACFAAAAAADAAAABQQAAAAABgQEAAAAAwEAAxQAAAAAAwAAAAUEAAAAAAYEBAAAAAMBAAsUAAAAAAMAAAAFBAAAAAAGBAQAAAADAQABugAAAAABAAEBAAIBAAMBAAQGCgAAAEEAcgBpAGEAbAAFBgoAAABBAHIAaQBhAGwABwYKAAAAQQByAGkAYQBsAAYGCgAAAEEAcgBpAGEAbAAIBBYAAAAKAQAMAQAmBAAAAAAPAQAQAQARAQAnBAAAAAAUAQAVAQAWBBYAAAAXAQAYAQAZBgoAAABkAGUALQBEAEUAGgYKAAAAYQByAC0AUwBBABsGCgAAAGUAbgAtAFUAUwAcBgIAAAAAAB4BAAL8BgAAAPcGAAABBgAAADUAMgAzAAIUAAAAVABhAGIAbABlACAARwByAGkAZAAJAQAAAAQDBgAAADQAMwA5AAsEAAAAOwAAAAW6AAAAAAEAAQEAAgEAAwEABAYKAAAAQQByAGkAYQBsAAUGCgAAAEEAcgBpAGEAbAAHBgoAAABBAHIAaQBhAGwABgYKAAAAQQByAGkAYQBsAAgEFgAAAAoBAAwBACYEAAAAAA8BABABABEBACcEAAAAABQBABUBABYEFgAAABcBABgBABkGCgAAAGQAZQAtAEQARQAaBgoAAABhAHIALQBTAEEAGwYKAAAAZQBuAC0AVQBTABwGAgAAAAAAHgEABtwAAAAAAQABBhIAAAAkBAAAAAAlBAAAAAAmBAAAAAAFAQEGAQAHAQAIAQAJBhsAAAAnBPAAAAALAQEcAQAoBAAAAAAdAQApBAAAAAAOBggAAAAAAQEBA////xkBARsGfQAAAAAUAAAAAAMAAAAFBAAAAAAGBAQAAAADAQABFAAAAAADAAAABQQAAAAABgQEAAAAAwEAAhQAAAAAAwAAAAUEAAAAAAYEBAAAAAMBAAMUAAAAAAMAAAAFBAAAAAAGBAQAAAADAQALFAAAAAADAAAABQQAAAAABgQEAAAAAwEABxcBAAAPBAAAAAEAAAAQBAAAAAEAAAACAQAAAAETBAAAAAAAAAAECQAAAAABAAIEAAAAAAU4AAAAAAkAAAAAAQECBGwAAAABCQAAAAABAQIEAAAAAAIJAAAAAAEBAgRsAAAAAwkAAAAAAQECBAAAAAAGlgAAAAAUAAAAAAMAAAAFBAAAAAAGBAQAAAADAQEBFAAAAAADAAAABQQAAAAABgQEAAAAAwEBAhQAAAAAAwAAAAUEAAAAAAYEBAAAAAMBAQMUAAAAAAMAAAAFBAAAAAAGBAQAAAADAQEEFAAAAAADAAAABQQAAAAABgQEAAAAAwEBBRQAAAAAAwAAAAUEAAAAAAYEBAAAAAMBAQwBAAAAAREAAAAAEgAAAAAPPAAAAAABAAwGFQAAAAEEAAAAAAgGCQAAAAABAAIEAAAAAA0GFQAAAAIEAAAAAAkGCQAAAAABAAIEAAAAAAMBARAkAAAAAAQBAAAAAgYAAAAAAwYJAAAAAAEAAgQAAAAABAEABQEBDwEBEY4DAAAAQQAAAAEBAAAAAAIAAAAAAxIAAAABBgAAAAAJBgAAAAAbBgAAAAAECgAAAAUAAAAABgAAAAAFAAAAAAYGAAAAAgYAAAAAAEEAAAABAQAAAAECAAAAAAMSAAAAAQYAAAAACQYAAAAAGwYAAAAABAoAAAAFAAAAAAYAAAAABQAAAAAGBgAAAAIGAAAAAABBAAAAAQEAAAACAgAAAAADEgAAAAEGAAAAAAkGAAAAABsGAAAAAAQKAAAABQAAAAAGAAAAAAUAAAAABgYAAAACBgAAAAAAQQAAAAEBAAAAAwIAAAAAAxIAAAABBgAAAAAJBgAAAAAbBgAAAAAECgAAAAUAAAAABgAAAAAFAAAAAAYGAAAAAgYAAAAAAEEAAAABAQAAAAQCAAAAAAMSAAAAAQYAAAAACQYAAAAAGwYAAAAABAoAAAAFAAAAAAYAAAAABQAAAAAGBgAAAAIGAAAAAABBAAAAAQEAAAAFAgAAAAADEgAAAAEGAAAAAAkGAAAAABsGAAAAAAQKAAAABQAAAAAGAAAAAAUAAAAABgYAAAACBgAAAAAAQQAAAAEBAAAABgIAAAAAAxIAAAABBgAAAAAJBgAAAAAbBgAAAAAECgAAAAUAAAAABgAAAAAFAAAAAAYGAAAAAgYAAAAAAEEAAAABAQAAAAcCAAAAAAMSAAAAAQYAAAAACQYAAAAAGwYAAAAABAoAAAAFAAAAAAYAAAAABQAAAAAGBgAAAAIGAAAAAABBAAAAAQEAAAAJAgAAAAADEgAAAAEGAAAAAAkGAAAAABsGAAAAAAQKAAAABQAAAAAGAAAAAAUAAAAABgYAAAACBgAAAAAAQQAAAAEBAAAACAIAAAAAAxIAAAABBgAAAAAJBgAAAAAbBgAAAAAECgAAAAUAAAAABgAAAAAFAAAAAAYGAAAAAgYAAAAAAEEAAAABAQAAAAsCAAAAAAMSAAAAAQYAAAAACQYAAAAAGwYAAAAABAoAAAAFAAAAAAYAAAAABQAAAAAGBgAAAAIGAAAAAABBAAAAAQEAAAAKAgAAAAADEgAAAAEGAAAAAAkGAAAAABsGAAAAAAQKAAAABQAAAAAGAAAAAAUAAAAABgYAAAACBgAAAAAAQQAAAAEBAAAADAIAAAAAAxIAAAABBgAAAAAJBgAAAAAbBgAAAAAECgAAAAUAAAAABgAAAAAFAAAAAAYGAAAAAgYAAAAA" cellspacing="0" border="0" cellpadding="0" style="margin-left:0pt;mso-padding-alt:0pt 5.3858267716535435pt 0pt 5.3858267716535435pt;border-left:0.5pt solid #000000;border-top:0.5pt solid #000000;border-right:0.5pt solid #000000;border-bottom:0.5pt solid #000000;mso-border-insidev:0.5pt solid #000000;mso-border-insideh:0.5pt solid #000000;" | |||
|+ | |||
| style="width:120.45000000000002pt;" width="161" |<span style="color: #000000">Erstrangtherapien</span> | |||
| style="width:276.4pt;" width="369" | | |||
| style="width:70.90000000000003pt;" width="95" |<span style="color: #000000">Dauer</span> | |||
|- | |||
| style="width:120.45000000000002pt;" width="161" |<span style="color: #000000">Bismuth-Qudrupeltherapie</span> | |||
| style="width:276.4pt;" width="369" |<span style="color: #000000">PPI 2 x tgl. 1 Standarddosis</span> | |||
<span style="color: #000000">Bismuth-Kaliumsalz/ Tetracyclin/ Metronidazol</span> | |||
<span style="color: #000000">4 x 3 Hartkapseln</span> | |||
| style="width:70.90000000000003pt;" width="95" |<span style="color: #000000">10 Tage</span> | |||
|- | |||
| style="width:120.45000000000002pt;" width="161" |<span style="color: #000000">Französische Tripeltherapie</span> | |||
| style="width:276.4pt;" width="369" |<span style="color: #000000">PPI 2 x tgl. 1 Standarddosis</span> | |||
<span style="color: #000000">Amoxicillin 2-3 x 1000 mg</span> | |||
<span style="color: #000000">Clarithromycin 2 x 500 mg</span> | |||
| style="width:70.90000000000003pt;" width="95" |<span style="color: #000000">10-14 Tage</span> | |||
|- | |||
| style="width:120.45000000000002pt;" width="161" |<span style="color: #000000">Italienische Tripeltherapie</span> | |||
| style="width:276.4pt;" width="369" |<span style="color: #000000">PPI 2 x tgl. 1 Standarddosis</span> | |||
<span style="color: #000000">Metronidazol 2 x 400 mg</span> | |||
<span style="color: #000000">Clarithromycin 2 x 500 mg</span> | |||
| style="width:70.90000000000003pt;" width="95" |<span style="color: #000000">10-14 Tage</span> | |||
|- | |||
| style="width:120.45000000000002pt;" width="161" |<span style="color: #000000">Komkomittierende Vierfachtherapie</span> | |||
<span style="color: #000000">Sollten wir evtl. nicht hineinnehmen - M. Oette</span> | |||
| style="width:276.4pt;" width="369" |<span style="color: #000000">PPI 2 x tgl. 1 Standarddosis</span> | |||
<span style="color: #000000">Amoxicillin 2 x 1000 mg</span> | |||
<span style="color: #000000">Clarithromycin 2 x 500 mg</span> | |||
<span style="color: #000000">Metronidazol 2 x 400 mg</span> | |||
| style="width:70.90000000000003pt;" width="95" |<span style="color: #000000">10-14 Tage</span> | |||
|- | |||
| style="width:120.45000000000002pt;" width="161" | | |||
| style="width:276.4pt;" width="369" | | |||
| style="width:70.90000000000003pt;" width="95" | | |||
|- | |||
| style="width:120.45000000000002pt;" width="161" |<span style="color: #000000">Alternative Schemata</span> | |||
| style="width:276.4pt;" width="369" | | |||
| style="width:70.90000000000003pt;" width="95" | | |||
|- | |||
| style="width:120.45000000000002pt;" width="161" |<span style="color: #000000">Fluorchinolon-Tripeltherapie I</span> | |||
| style="width:276.4pt;" width="369" |<span style="color: #000000">PPI 2 x tgl. 1 Standarddosis</span> | |||
<span style="color: #000000">Levofloxacin 500 mg oder Moxifloxacin 400 mg 1 x tgl.</span> | |||
<span style="color: #000000">Amoxicillin 2-3 x 1000 mg</span> | |||
| style="width:70.90000000000003pt;" width="95" |<span style="color: #000000">10-14 Tage</span> | |||
|- style="height:12.65ptpx;" | |||
| style="width:120.45000000000002pt;" width="161" |<span style="color: #000000">Fluorchinolon-Tripeltherapie II</span> | |||
| style="width:276.4pt;" width="369" |<span style="color: #000000">PPI 2 x tgl. 1 Standarddosis</span> | |||
<span style="color: #000000">Levofloxacin 500 mg oder Moxifloxacin 400 mg 1 x tgl.</span> | |||
<span style="color: #000000">Rifabutin 2 x 150 mg</span> | |||
| style="width:70.90000000000003pt;" width="95" |<span style="color: #000000">10-14 Tage</span> | |||
|- style="height:12.65ptpx;" | |||
| style="width:120.45000000000002pt;" width="161" |<span style="color: #000000">Sequenztherapie</span> | |||
<span style="color: #000000">Sollten wir nicht hineinnehmen - M. Oette</span> | |||
| style="width:276.4pt;" width="369" |<span style="color: #000000">PPI 2 x tgl. 1 Standarddosis</span> | |||
<span style="color: #000000">Amoxicillin 2-3 x 1000 mg (Tag 1-5)</span> | |||
<span style="color: #000000">Clarithromycin 2 x 500 mg (Tage 6-10)</span> | |||
<span style="color: #000000">Metronidazol 2 x 400 mg (Tage 6-10)</span> | |||
| style="width:70.90000000000003pt;" width="95" |<span style="color: #000000">10 Tage</span> | |||
|- style="height:12.65ptpx;" | |||
| style="width:120.45000000000002pt;" width="161" | | |||
| style="width:276.4pt;" width="369" | | |||
| style="width:70.90000000000003pt;" width="95" | | |||
|- style="height:12.65ptpx;" | |||
| colspan="2" style="width:396.85pt;" width="529" |<span style="color: #000000">Äquivalenzdosierungen der Protonenpumpenhemmer (PPI)</span> | |||
| style="width:70.90000000000003pt;" width="95" | | |||
|- style="height:12.65ptpx;" | |||
| style="width:120.45000000000002pt;" width="161" | | |||
| style="width:276.4pt;" width="369" |<span style="color: #000000">Omeprazol 20 mg</span> | |||
<span style="color: #000000">Esomeprazol 20 mg</span> | |||
<span style="color: #000000">Pantoprazol 40 mg</span> | |||
<span style="color: #000000">Lansoprazol 30 mg</span> | |||
<span style="color: #000000">Rabeprazol 20 mg</span> | |||
| style="width:70.90000000000003pt;" width="95" | | |||
|} | |||
Aufgrund der zunehmenden Resistenzen, v.a. gegenüber Metronidazol, Clarythromycin und Levofloxazin, kommt der Bismuth-Quadrupel-Therapie eine überragende Bedeutung zu. Einschränkungen sind der Preis, die hohe Zahl von Tabletten und die Verträglichkeit. Aus der Perspektive der Antibiotikaresistenz ist dieses Schema jedoch als effektiver im Vergleich zu den anderen Kombinationen einzuschätzen. In neuen Bismuth-haltigen Kombinationen ersetzt das Amoxicillin entweder das Tetracyclin oder das Metronidazol. | |||
Bei Patienten aus Osteuropa, dem Mittelmeer-Raum und nach erfolgter Makrolidbehandlung sollte diese Antibiotikagfruppe nicht zum Einsatz kommen. Bei Vorliegen eines Resistenztestbefundes kann die Antibiotikakombination nach dem Ergebnis der Empfindlichkeitsprüfung vorgenommen werden. Dieses Vorgehen sollte bei erfolglosen Eradikationsversuchen in der Vergangenheit gewählt werden. | |||
Sie darf als Standard nach erfolgloser Erstbehandlung angesehen werden. Eine zusätzliche Probiotikagabe zu einer Eradikationstherapie kann erfolgen, um die Verträglichkeit der Eradikationsbehandlung zu verbessern. dies wird jedoch kontrovers beurteilt. | |||
Bei komplizierten U. duodeni + bei U. ventriculi muss eine Therapiekontrolle erfolgen. | |||
<br /> | |||
Revision as of 11:33, 17 February 2021
Therapie
Indikation zur Behandlung
- Bei peptischen Ulcus ventriculi oder Ulcus duodeni
- Bei gastralen MALT-Lymphomen
- Bei diffus-großzelligen B-Zell-Lymphom des Magens
- B-Gastritis zur Karzinomprophylaxe, insbesondere bei positiver Familienanamnese
- Bei Nachweis von Adenomen oder hyperplastischen Magenpolypen
- Bei Patienten mit einer ITP, Morbus Menier oder einer lymphozytären Gastritis
- Vor Antikoagulation bzw. Dauermedikation mit ASS oder NSAR bei gleichzeitiger Ulcusanamnese
Behandlung kann angeboten werden
- Bei Patienten mit asympt. Hp-Gastritis
- Bei SSRI-Komedikation
- Bei anderen extragastralen Manifestationen
- Bei Hp-Gastritis und Eisenmangelanämie
Zurückhaltende/ keine Indikation
- Dyspepsie
- Refluxsymptome oder eine Refluxösophagitis
- Bei ungeklärter Eisenmangelanämie
Antibiotikatherapien
| Erstrangtherapien | Dauer | |
| Bismuth-Qudrupeltherapie | PPI 2 x tgl. 1 Standarddosis
Bismuth-Kaliumsalz/ Tetracyclin/ Metronidazol 4 x 3 Hartkapseln |
10 Tage |
| Französische Tripeltherapie | PPI 2 x tgl. 1 Standarddosis
Amoxicillin 2-3 x 1000 mg Clarithromycin 2 x 500 mg |
10-14 Tage |
| Italienische Tripeltherapie | PPI 2 x tgl. 1 Standarddosis
Metronidazol 2 x 400 mg Clarithromycin 2 x 500 mg |
10-14 Tage |
| Komkomittierende Vierfachtherapie
Sollten wir evtl. nicht hineinnehmen - M. Oette |
PPI 2 x tgl. 1 Standarddosis
Amoxicillin 2 x 1000 mg Clarithromycin 2 x 500 mg Metronidazol 2 x 400 mg |
10-14 Tage |
| Alternative Schemata | ||
| Fluorchinolon-Tripeltherapie I | PPI 2 x tgl. 1 Standarddosis
Levofloxacin 500 mg oder Moxifloxacin 400 mg 1 x tgl. Amoxicillin 2-3 x 1000 mg |
10-14 Tage |
| Fluorchinolon-Tripeltherapie II | PPI 2 x tgl. 1 Standarddosis
Levofloxacin 500 mg oder Moxifloxacin 400 mg 1 x tgl. Rifabutin 2 x 150 mg |
10-14 Tage |
| Sequenztherapie
Sollten wir nicht hineinnehmen - M. Oette |
PPI 2 x tgl. 1 Standarddosis
Amoxicillin 2-3 x 1000 mg (Tag 1-5) Clarithromycin 2 x 500 mg (Tage 6-10) Metronidazol 2 x 400 mg (Tage 6-10) |
10 Tage |
| Äquivalenzdosierungen der Protonenpumpenhemmer (PPI) | ||
| Omeprazol 20 mg
Esomeprazol 20 mg Pantoprazol 40 mg Lansoprazol 30 mg Rabeprazol 20 mg |
||
Aufgrund der zunehmenden Resistenzen, v.a. gegenüber Metronidazol, Clarythromycin und Levofloxazin, kommt der Bismuth-Quadrupel-Therapie eine überragende Bedeutung zu. Einschränkungen sind der Preis, die hohe Zahl von Tabletten und die Verträglichkeit. Aus der Perspektive der Antibiotikaresistenz ist dieses Schema jedoch als effektiver im Vergleich zu den anderen Kombinationen einzuschätzen. In neuen Bismuth-haltigen Kombinationen ersetzt das Amoxicillin entweder das Tetracyclin oder das Metronidazol.
Bei Patienten aus Osteuropa, dem Mittelmeer-Raum und nach erfolgter Makrolidbehandlung sollte diese Antibiotikagfruppe nicht zum Einsatz kommen. Bei Vorliegen eines Resistenztestbefundes kann die Antibiotikakombination nach dem Ergebnis der Empfindlichkeitsprüfung vorgenommen werden. Dieses Vorgehen sollte bei erfolglosen Eradikationsversuchen in der Vergangenheit gewählt werden.
Sie darf als Standard nach erfolgloser Erstbehandlung angesehen werden. Eine zusätzliche Probiotikagabe zu einer Eradikationstherapie kann erfolgen, um die Verträglichkeit der Eradikationsbehandlung zu verbessern. dies wird jedoch kontrovers beurteilt.
Bei komplizierten U. duodeni + bei U. ventriculi muss eine Therapiekontrolle erfolgen.