Schulz Christian, Liou Jyh-Ming, Alboraie Mohamed, Bornschein Jan, Campos Nunez Christian, Coelho Luiz Gonzaga, Quach Duc Trong, Fallone Carlo A, Chen Yi-Chu, Gerhard Markus, Gisbert Javier P, Jung Hwoon-Yong, Katelaris Peter H, Kim Jae Gyu, Lu Hong, Macke Lukas, Mahachai Varocha, Moss Steven F, Remes Troche Jose Maria, Riquelme Arnoldo, Romano Marco, Setshedi Mashiko, Smith Stella, Suerbaum Sebastian, Tshibangu-Kabamba Evariste, Vilaichone Ratha-Korn, Yadegar Abbas, Yamaoka Yoshio, Mégraud Francis, El-Omar Emad M, Sugano Kentaro, Malfertheiner Peter
Medical Department 2, LMU Munich, Munich, Germany
German Center for Infection Research (DZIF), partner site Munich, Munich, Germany.
Gut. 2025 Jul 11. doi: 10.1136/gutjnl-2025-335523.
resistance to antibiotics commonly used in eradication regimens is increasing dramatically in many locations; new strategies are needed to manage this infectious disease.
This study's aim was to collect and update information on antibiotic resistance (AR) rates in as well as current strategies for management, including public health issues, from a global perspective.
An international survey was conducted in 31 countries on 6 continents to address key issues concerning the management of -related AR. Individual aspects included the prevalence of AR for specific antibiotics, antibiotic susceptibility testing (AST) in different healthcare systems, availability of drugs, reimbursement issues and strategies for AR surveillance.
Resistance to the most effective antibiotics used in eradication regimens is increasing globally, with clarithromycin and levofloxacin resistance exceeding 15% in 24/31 and 18/31 countries, respectively. Amoxicillin remains an exception, with resistance rates under 2% in 14/31 countries; though African countries have reported amoxicillin resistance rates of over 90%. Bismuth-based treatment regimens are the most effective and are recommended as first-line treatment in several countries. However, more than 1 billion inhabitants worldwide have no access to bismuth-based regimens. PCR-based tests for AR are used in 16/26 countries but are reimbursed in only 4, while next generation sequencing-based tests are available, but not reimbursed, in 3 countries. In 22/26 countries only culture-based methods are available (reimbursed in 9/26 countries). AR surveillance programmes have only been established in 4/26 countries. Therefore, in most countries, empirical therapy with the most effective local regimen available locally is practiced.
The dramatic global rise in antibiotic resistance requires an urgent revision of current management strategies. Possible solutions include AST-based selection of effective treatment regimens, identification of novel combinations of existing drugs and exploration of novel drugs.
在许多地区，根除治疗方案中常用抗生素的耐药性正在急剧上升；需要新的策略来管理这种传染病。
本研究的目的是从全球角度收集并更新关于[疾病名称]抗生素耐药率以及当前管理策略（包括公共卫生问题）的信息。
在六大洲的31个国家进行了一项国际调查，以解决与[疾病名称]相关的抗生素耐药性管理的关键问题。具体方面包括特定抗生素的耐药率、不同医疗系统中的抗生素敏感性测试（AST）、药物可用性、报销问题以及[疾病名称]抗生素耐药性监测策略。
全球范围内，用于[疾病名称]根除治疗方案的最有效抗生素的耐药性正在增加，克拉霉素和左氧氟沙星的耐药率在24/31和18/31个国家分别超过15%。阿莫西林仍然是个例外，在14/31个国家耐药率低于2%；不过非洲国家报告的阿莫西林耐药率超过90%。含铋治疗方案是最有效的，在几个国家被推荐为一线治疗。然而，全球超过10亿居民无法获得含铋治疗方案。16/26个国家使用基于PCR的抗生素耐药性检测，但只有4个国家给予报销，基于下一代测序的检测在3个国家可用但未获报销。在22/26个国家仅提供基于培养的方法（9/26个国家给予报销）。抗生素耐药性监测项目仅在4/26个国家建立。因此，在大多数国家，采用当地可用的最有效局部治疗方案进行经验性治疗。
全球范围内[疾病名称]抗生素耐药性的急剧上升需要紧急修订当前的管理策略。可能的解决方案包括基于AST选择有效的治疗方案、确定现有药物的新组合以及探索新型药物。
