Rational Helicobacter pylori Therapy
Similar to other infectious diseases, treatment results are best when reliably excellent regimens are used to treat patients with organisms susceptible to the antimicrobials chosen. Pretreatment susceptibility testing, either by culture of the organism or indirectly by molecular testing of stools of infected patients or fluorescent in-situ hybridization using paraffin-embedded gastric biopsy specimens, allows one to select a regimen tailored by antimicrobial susceptibility (ie, tailored therapy). However, in many instances, one must choose therapy empirically and, in this instance, the best approach is to use regimens that have been proven to be reliably excellent locally. That choice should take advantage of knowledge of resistance patterns obtained from local or regional antimicrobial surveillance programs and/or based on local clinical experience with regard to which regimens are effective locally. Finally, the history of the patient's prior antibiotic use and any prior therapies will help identify which antibiotics are likely to be successful and those for which resistance is probable (Figure 1).
(Enlarge Image)
Figure 1.
Recommended approach to treatment of H pylori infections. Rx, treatment.
All other things being equal, data from any area or region regarding the effects of resistance on outcome can be used reliably to predict outcome in any other area. Thus, strains with similar patterns of resistance in Italy, the United States, Iran, China, and so forth should be expected to respond alike such that, if one knows the results with susceptible and with resistant strains in one place, one reasonably can predict the outcome of therapy anywhere.
Therapy Choice
Similar to other infectious diseases, treatment results are best when reliably excellent regimens are used to treat patients with organisms susceptible to the antimicrobials chosen. Pretreatment susceptibility testing, either by culture of the organism or indirectly by molecular testing of stools of infected patients or fluorescent in-situ hybridization using paraffin-embedded gastric biopsy specimens, allows one to select a regimen tailored by antimicrobial susceptibility (ie, tailored therapy). However, in many instances, one must choose therapy empirically and, in this instance, the best approach is to use regimens that have been proven to be reliably excellent locally. That choice should take advantage of knowledge of resistance patterns obtained from local or regional antimicrobial surveillance programs and/or based on local clinical experience with regard to which regimens are effective locally. Finally, the history of the patient's prior antibiotic use and any prior therapies will help identify which antibiotics are likely to be successful and those for which resistance is probable (Figure 1).
(Enlarge Image)
Figure 1.
Recommended approach to treatment of H pylori infections. Rx, treatment.
All other things being equal, data from any area or region regarding the effects of resistance on outcome can be used reliably to predict outcome in any other area. Thus, strains with similar patterns of resistance in Italy, the United States, Iran, China, and so forth should be expected to respond alike such that, if one knows the results with susceptible and with resistant strains in one place, one reasonably can predict the outcome of therapy anywhere.
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