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Transitioning of Helicobacter pylori Therapy from Trial and Error to Antimicrobial Stewardship

Department of Medicine, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, RM 3A-318B (111D), 2002 Holcombe Boulevard, Houston, TX 77030, USA
Received: 15 September 2020 / Revised: 28 September 2020 / Accepted: 1 October 2020 / Published: 3 October 2020
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship)
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. View Full-Text
Keywords: Helicobacter pylori; antimicrobial stewardship; therapy; antibiotics; metronidazole; clarithromycin; fluoroquinolones; amoxicillin; proton pump inhibitors; ethical trials Helicobacter pylori; antimicrobial stewardship; therapy; antibiotics; metronidazole; clarithromycin; fluoroquinolones; amoxicillin; proton pump inhibitors; ethical trials
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MDPI and ACS Style

Graham, D.Y. Transitioning of Helicobacter pylori Therapy from Trial and Error to Antimicrobial Stewardship. Antibiotics 2020, 9, 671. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics9100671

AMA Style

Graham DY. Transitioning of Helicobacter pylori Therapy from Trial and Error to Antimicrobial Stewardship. Antibiotics. 2020; 9(10):671. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics9100671

Chicago/Turabian Style

Graham, David Y. 2020. "Transitioning of Helicobacter pylori Therapy from Trial and Error to Antimicrobial Stewardship" Antibiotics 9, no. 10: 671. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics9100671

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Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

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