我们提供了一个引物,以帮助将幽门螺杆菌治疗指南艰难地过渡到遵守抗菌药物管理原则的指南。这种过渡将需要放弃迄今为止构成治疗指南和建议基础的许多原则。抗菌药物管理的目标包括优化抗生素的使用,同时降低抗菌药物耐药性。关键结果衡量标准是绝对治愈率,这在很大程度上限制了比较试验,以可靠地产生高治愈率(例如,95%)。不能达到至少90%治愈率的疗法应该被放弃为不可接受的。因为只有优化的疗法才应该开处方,我们需要关于优化原则和实践的指导。应消除含有对结果没有贡献的抗生素的疗法。监视,抗菌药物管理的基本要素之一,必须这样做,以提供持续的保证,建议的治疗仍然有效。当使用其他非常成功的疗法时,它尚未得到广泛认可。固化数据的常规测试是间接的,敏感性试验的替代方法。为了系统地指导治疗,应收集固化数据测试,共享并整合到当地的抗菌药物管理计划中,以便为处方者和公共卫生人员提供有关最佳实践的指导。治疗建议应与美国传染病学会白皮书中的有关抗菌药物治疗由耐药细菌病原体引起的感染的优越性和特定于生物体的临床试验相一致,其中包括伦理主动控制的标准抗菌药物的优越性研究。
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, ∼95%). 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 drug-resistant bacterial pathogens which include criteria for ethical active-controlled superiority studies of antibacterial agents.