Helicobacter pylori is the only major infection for which antimicrobial therapy is not designed using the principles of antimicrobial stewardship. Traditionally, antimicrobial therapy is a susceptibility-based therapy, achieves high cure rates, and includes surveillance programs to regularly provide updated data regarding resistance, outcomes, and treatment guidelines. Current H. pylori therapies identified by trial-and-error, and treatment recommendations and guidelines are based on comparisons among regimens that rarely take into account the prevalence or effect of resistance. The majority of patients currently treated achieve suboptimal results. A paradigm shift is required to abandon current approaches and embrace antimicrobial stewardship, and therefore reliably achieve high cure rates; develop, propagate, and update best practice guidelines; and provide surveillance of local or regional susceptibility/resistance patterns. These also require timely updates to clinicians regarding the current status of resistance, antimicrobial effectiveness, and ways to prevent antimicrobial misuse to extend the useful life of currently available antibiotics. Here, we discuss the differences among current approaches to H. pylori therapy and antimicrobial stewardship and identify what is required to achieve the transition. Conceptually, the differences are significant, and the transition will likely need to be both abrupt and complete. Recommendations for therapy during the transition period are given.

中文翻译：

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幽门螺杆菌治疗从试验和错误过渡到抗菌素管理

幽门螺杆菌是唯一未采用抗菌管理原则进行抗菌治疗的重大感染。传统上，抗菌疗法是一种基于药敏性的疗法，可以达到很高的治愈率，并且包括监测程序，以定期提供有关耐药性，结果和治疗指南的最新数据。目前幽门螺杆菌通过反复试验确定的疗法以及治疗建议和指南，是基于方案之间的比较，而这些方案很少考虑耐药性的发生率或影响。目前接受治疗的大多数患者均未达到最佳效果。需要放弃现有方法并进行抗菌管理，从而可靠地实现高治愈率；制定，传播和更新最佳实践准则；并提供对本地或区域敏感性/耐药性模式的监视。这些还要求及时向临床医生更新耐药性的现状，抗菌效果以及防止滥用抗生素以延长当前可用抗生素使用寿命的方法。在这里，我们讨论了当前方法之间的差异幽门螺杆菌治疗和抗菌素管理，确定实现过渡所需的条件。从概念上讲，差异是很大的，过渡可能需要既突然又完整。给出了过渡期治疗的建议。