Publication Date

1-1-2023

Journal

Expert Review of Gastroenterology & Hepatology

DOI

10.1080/17474124.2023.2162502

PMID

36594260

PMCID

PMC9839552

PubMedCentral® Posted Date

1-4-2024

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Humans, Helicobacter Infections, Helicobacter pylori, Drug Therapy, Combination, Anti-Bacterial Agents, Anti-Infective Agents, Drug Resistance, Bacterial, Clarithromycin, Helicobacter pylori, therapy, susceptibility testing, antimicrobial stewardship, antibiotics

Abstract

Introduction:

Until recently antimicrobial therapy for Helicobacter pylori infections was almost universally empirical and based on a combination of expert opinion and local effectiveness. However, the average cure rates rarely achieved more than 80%. The new requirement that all therapeutic regimens reliably achieve high cure rates, the introduction of potassium competitive acid blockers and the availability of susceptibility testing many pharmacological opportunities particularly since all current therapies will require optimization. The ability to rapidly and inexpensively obtain H. pylori susceptibility data using stool samples makes obtaining susceptibility data practical and allows using susceptibility-based therapy routinely for both treatment naïve patient and as well as treatment failures.

Areas covered:

We searched the literature from 1990 to current to identify studies reporting the effect of susceptibility testing on H. pylori treatment. This review examines how widespread and convenient H. pylori susceptibility testing will result in pharmacological opportunities. Availability of susceptibility data will promote embracing the principles of antimicrobial stewardship, and reliably achieving high cure rates. The addition of susceptibility testing to post treatment failures helps explain why treatment fails. Many pharmacological opportunities will emanate from a renewal of efforts to develop, propagate, confirm and update best practices based on local and regional susceptibility/resistance patterns.

Expert opinion:

The ability to evaluate treatment decisions and outcomes in susceptible infections and reliably achieve high cure rates should foster precise tailoring of pharmacologic therapy and should achieve the goals of high cure rates while preventing antimicrobial misuse and extending the useful life of current antibiotics.

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