S1348 Triple Therapy for Primary Treatment of Helicobacter pylori: A 19-Year U.S. Single Center Experience

Ginnebaugh, Brian; Baker, Jason; Watts, Lydia; Saad, Richard J.; Kao, John Y.; Chey, William D.

doi:10.14309/01.ajg.0000707440.64691.0e

Cited by 7 publications

(9 citation statements)

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“…The importance of these data has been greatly underestimated, and there are many examples of test of cure data routinely collected and even linked to individual treatments without understanding how it could best be utilized. 17,24 Fundamentally, if the regimen is one that reliably provides high cure rates with susceptible infections, the test of cure data provides an indirect assessment of susceptibility and resistance and can be used systematically to guide therapy. 17,24 It is important to collect and share these data with other physicians, but especially with those with charged with collecting and disseminating local resistance and susceptibility data for infectious diseases.…”

Section: Susceptibility Testingmentioning

confidence: 99%

“…17,24 Fundamentally, if the regimen is one that reliably provides high cure rates with susceptible infections, the test of cure data provides an indirect assessment of susceptibility and resistance and can be used systematically to guide therapy. 17,24 It is important to collect and share these data with other physicians, but especially with those with charged with collecting and disseminating local resistance and susceptibility data for infectious diseases. The data, along with monitoring of prescription practices, should be integrated into local antimicrobial stewardship programs designed to provide guidance regarding best practices to both prescribers and public health individuals.…”

Section: Susceptibility Testingmentioning

confidence: 99%

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Primer for Development of Guidelines for Helicobacter pylori Therapy Using Antimicrobial Stewardship

Graham

Liou

2022

Clinical Gastroenterology and Hepatology

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We provide a primer to assist in the difficult transition of Helicobacter pylori therapy guidelines to those that adhere to the principles of antimicrobial stewardship. This transition will entail abandonment of many of the principles that heretofore formed the basis of treatment guidelines and recommendations. The goals of antimicrobial stewardship include optimization of the use of antibiotics while reducing antimicrobial resistance. The critical outcome measure is absolute cure rate which largely restricts comparative trials to those which reliably produce high cure rates (eg, w95%). Therapies that fail to achieve at least a 90% cure rate should be abandoned as unacceptable. Because only optimized therapies should be prescribed, guidance on the principles and practices of optimization will we required. Therapies that contain antibiotics which do not contribute to outcome should be eliminated. Surveillance, one of the fundamental elements of antimicrobial stewardship, must be done to provide ongoing assurance that the recommended therapies remain effective. It is yet not widely recognized when utilizing otherwise highly successful therapies, the routine test of cure data is an indirect, surrogate method for susceptibility testing. To systematically guide therapy, test of cure data should be collected, shared and integrated into local antimicrobial stewardship programs to provide guidance regarding best practices to both prescribers and public health individuals. Treatment recommendations should be compatible with those of the American Society of Infectious Disease white paper on the conduct of superiority and organism-specific clinical trials of antibacterial agents for the treatment of infections caused by drugresistant bacterial pathogens which include criteria for ethical active-controlled superiority studies of antibacterial agents.

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Section: Susceptibility Testingmentioning

confidence: 99%

Section: Susceptibility Testingmentioning

confidence: 99%

Primer for Development of Guidelines for Helicobacter pylori Therapy Using Antimicrobial Stewardship

Graham

Liou

2022

Clinical Gastroenterology and Hepatology

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Section: The Importance Of Understanding the Mechanism Of Treatment Failurementioning

confidence: 99%

“…As such, decades of local treatment failures have been recorded and published as observations rather than as critical opportunities for providing better care. 6 , 7 , 33 , 54 …”

Section: Test-of-curementioning

confidence: 99%

“…31,32 Despite its poor clinical effectiveness, however, it remains one of the most utilized combinations. 33,34 Currently, the prevalence of resistance precludes the use of triple therapy with clarithromycin, fluoroquinolones, or metronidazole except as susceptibility-based therapies. 6 Choice of therapy A basic rule in the treatment of infectious disease is to prescribe only therapies empirically in which high local effectiveness has been both proven and confirmed.…”

Section: The Importance Of Understanding the Mechanism Of Treatment F...mentioning

confidence: 99%

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Helicobacter pylori diagnosis and therapy in the era of antimicrobial stewardship

Shiotani

Roy

Lü

et al. 2021

Therap Adv Gastroenterol

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The diagnosis and therapy of Helicobacter pylori infection have undergone major changes based on the use the principles of antimicrobial stewardship and increased availability of susceptibility profiling. H. pylori gastritis now recognized as an infectious disease, as such there is no placebo response allowing outcome to be assessed in relation to the theoretically obtainable cure rate of 100%. The recent recognition of H. pylori as an infectious disease has changed the focus to therapies optimized to reliably achieve high cure rates. Increasing antimicrobial resistance has also led to restriction of clarithromycin, levofloxacin, or metronidazole to susceptibility-based therapies. Covid-19 resulted in the almost universal availability of polymerase chain reaction testing in hospitals which can be repurposed to utilize readily available kits to provide rapid and inexpensive detection of clarithromycin resistance. In the United States, major diagnostic laboratories now offer H. pylori culture and susceptibility testing and American Molecular Laboratories offers next-generation sequencing susceptibility profiling of gastric biopsies or stools for the six commonly used antibiotics without need for endoscopy. Current treatment recommendations include (a) only use therapies that are reliably highly effective locally, (b) always perform a test-of-cure, and (c) use that data to confirm local effectiveness and share the results to inform the community regarding which therapies are effective and which are not. Empiric therapy should be restricted to those proven highly effective locally. The most common choices are 14-day bismuth quadruple therapy and rifabutin triple therapy. Prior guidelines and treatment recommendations should only be used if proven locally highly effective.

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Helicobacter pylori infection treatment in the United States: clinical consequences and costs of eradication treatment failure

Shah

Hubscher

Pelletier³

et al. 2022

Expert Review of Gastroenterology & Hepatology

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S1348 Triple Therapy for Primary Treatment of Helicobacter pylori: A 19-Year U.S. Single Center Experience

Cited by 7 publications

References 0 publications

Primer for Development of Guidelines for Helicobacter pylori Therapy Using Antimicrobial Stewardship

Primer for Development of Guidelines for Helicobacter pylori Therapy Using Antimicrobial Stewardship

Helicobacter pylori diagnosis and therapy in the era of antimicrobial stewardship

Helicobacter pylori infection treatment in the United States: clinical consequences and costs of eradication treatment failure

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