How can we rationally select helicobacter pylori therapy without resistance data?

摘要

I greatly enjoyed reading the review of Helicobacter pylori therapy by Graham et al in the February issue of Clinical Gastroenterology and Hepatology. I completely agree that the treatment choice should be based on local success rates, which are largely predictable on the basis of knowledge of local H pylori resistance. Although information regarding the pattern of H pylori resistance to antibiotics is available for many countries and regions all over the world, there is unfortunately a great paucity of data in the United States, which is limiting rational evidence-based treatment in this country. The latest data from a small national sample derive from strains collected about 15 years ago before levo-floxacin usage was widely available and at a time when clarithromycin-based therapy had been standard for only about 5 years.Very few research laboratories throughout the country are currently performing H pylori resistance testing, and the only publicly available adult data in this regard in the past decade are from the native Alaska population and 2 small studies from Dr Graham's laboratory of a Texas Veterans Administration population.