HOW TO TREAT HELICOBACTER-PYLORI INFECTION - SHOULD TREATMENT STRATEGIES BE BASED ON TESTING BACTERIAL SUSCEPTIBILITY - A PERSONAL VIEWPOINT

Peptic ulcer disease is an infectious disease. Only antibiotic regimen s that achieve a 90% cure should be used to treat this infection. Anti microbial susceptibility is the main determinant in the success of the rapy; cure rates are usually lower in resistant strains. As in any oth er infectious disease it is essential in treatment studies to stratify results according to pretreatment bacterial susceptibility. Cure-rate s have to be reported separately for sensitive and resistant strains. It must be realized that a study achieving a high cure rate with a cer tain regimen can either have included few patients with resistant stra ins or, alternatively, the regimen tested can have a high efficacy in resistant strains. This issue is fundamental and only if that informat ion is available, do we know whether or not we can reproduce the resul ts reported in that particular study in a different population. We hav e reviewed all Helicobacter studies that tested pretreatment bacterial susceptibility. The results achieved with dual therapy, bismuth tripl e therapy, proton pump inhibitor triple therapy and quadruple therapy in sensitive and resistant strains are discussed. Based on these data, treatment recommendations are made for empirical treatment in areas w ith low resistance rates and those with high resistance rates. If trea tment is individualized and based on the antibiogram then easier, shor ter and cheaper regimens seem possible.