Transitioning of <i>Helicobacter pylori</i> Therapy from Trial and Error to Antimicrobial Stewardship
<i>Helicobacter pylori</i> 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 t...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-10-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/9/10/671 |
| _version_ | 1797551811395059712 |
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| author | David Y. Graham |
| author_facet | David Y. Graham |
| author_sort | David Y. Graham |
| collection | DOAJ |
| description | <i>Helicobacter pylori</i> 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 <i>H. pylori</i> 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 <i>H. pylori</i> 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. |
| first_indexed | 2024-03-10T15:51:23Z |
| format | Article |
| id | doaj.art-01b5f6ee4578413585c8ef9668a72d9a |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-10T15:51:23Z |
| publishDate | 2020-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-01b5f6ee4578413585c8ef9668a72d9a2023-11-20T16:01:00ZengMDPI AGAntibiotics2079-63822020-10-0191067110.3390/antibiotics9100671Transitioning of <i>Helicobacter pylori</i> Therapy from Trial and Error to Antimicrobial StewardshipDavid Y. Graham0Department of Medicine, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, RM 3A-318B (111D), 2002 Holcombe Boulevard, Houston, TX 77030, USA<i>Helicobacter pylori</i> 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 <i>H. pylori</i> 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 <i>H. pylori</i> 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.https://www.mdpi.com/2079-6382/9/10/671<i>Helicobacter pylori</i>antimicrobial stewardshiptherapyantibioticsmetronidazoleclarithromycin |
| spellingShingle | David Y. Graham Transitioning of <i>Helicobacter pylori</i> Therapy from Trial and Error to Antimicrobial Stewardship Antibiotics <i>Helicobacter pylori</i> antimicrobial stewardship therapy antibiotics metronidazole clarithromycin |
| title | Transitioning of <i>Helicobacter pylori</i> Therapy from Trial and Error to Antimicrobial Stewardship |
| title_full | Transitioning of <i>Helicobacter pylori</i> Therapy from Trial and Error to Antimicrobial Stewardship |
| title_fullStr | Transitioning of <i>Helicobacter pylori</i> Therapy from Trial and Error to Antimicrobial Stewardship |
| title_full_unstemmed | Transitioning of <i>Helicobacter pylori</i> Therapy from Trial and Error to Antimicrobial Stewardship |
| title_short | Transitioning of <i>Helicobacter pylori</i> Therapy from Trial and Error to Antimicrobial Stewardship |
| title_sort | transitioning of i helicobacter pylori i therapy from trial and error to antimicrobial stewardship |
| topic | <i>Helicobacter pylori</i> antimicrobial stewardship therapy antibiotics metronidazole clarithromycin |
| url | https://www.mdpi.com/2079-6382/9/10/671 |
| work_keys_str_mv | AT davidygraham transitioningofihelicobacterpyloriitherapyfromtrialanderrortoantimicrobialstewardship |