期刊
ANTIBIOTICS-BASEL
卷 9, 期 10, 页码 -出版社
MDPI
DOI: 10.3390/antibiotics9100671
关键词
Helicobacter pylori; antimicrobial stewardship; therapy; antibiotics; metronidazole; clarithromycin; fluoroquinolones; amoxicillin; proton pump inhibitors; ethical trials
资金
- Office of Research and Development Medical Research Service Department of Veterans Affairs, Washington DC
- Public Health Service grants - Texas Medical Center Digestive Diseases Center [DK56338]
Helicobacter pylori is the only major infection for which antimicrobial therapy is not designed using the principles of antimicrobial stewardship. Traditionally, antimicrobial therapy is a susceptibility-based therapy, achieves high cure rates, and includes surveillance programs to regularly provide updated data regarding resistance, outcomes, and treatment guidelines. Current H. pylori therapies identified by trial-and-error, and treatment recommendations and guidelines are based on comparisons among regimens that rarely take into account the prevalence or effect of resistance. The majority of patients currently treated achieve suboptimal results. A paradigm shift is required to abandon current approaches and embrace antimicrobial stewardship, and therefore reliably achieve high cure rates; develop, propagate, and update best practice guidelines; and provide surveillance of local or regional susceptibility/resistance patterns. These also require timely updates to clinicians regarding the current status of resistance, antimicrobial effectiveness, and ways to prevent antimicrobial misuse to extend the useful life of currently available antibiotics. Here, we discuss the differences among current approaches to H. pylori therapy and antimicrobial stewardship and identify what is required to achieve the transition. Conceptually, the differences are significant, and the transition will likely need to be both abrupt and complete. Recommendations for therapy during the transition period are given.
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