What Would the Screen-and-Treat Strategy for Helicobacter pylori Mean in Terms of Antibiotic Consumption?

Abstract

Several guidelines recommend the screen-and-treat strategy, i.e. active search for the presence of Helicobacter pylori infection and its eradication to prevent the possibility of gastric cancer. It is thought that a relatively short duration antibiotic regimen given once in a lifetime would not significantly increase overall antibiotic consumption. However, this would mean offering antibiotic treatment to the majority of the population in countries with the biggest burden of gastric cancer who would, therefore, have the greatest benefit from such a strategy. So far, no country has implemented an eradication strategy. With an example based on the current situation in Latvia, we have estimated the increase in antibiotic consumption if the screen-and-treat strategy was applied. Depending on the scenario that might be chosen, clarithromycin consumption would increase up to sixfold, and amoxicillin consumption would double if the recommendations of the current guideline in the local circumstances was applied. It appears that an increase in commonly used antibiotic consumption cannot be justified from the viewpoint of antibiotic stewardship policies. Solutions to this problem could be the use of antibiotics that are not required for treating life-threatening diseases or more narrow selection of the target group, e.g. young people before family planning to avoid transmission to offspring. Additional costs related to the increase in resistome should be considered for future cost-effectiveness modelling of the screen-and-treat strategy.

Keywords: Antibiotic stewardship; Cost-effectiveness; Gastric cancer; H. pylori; Prevention; Resistome; Screen-and-treat.

Fig. 1

Estimated antibiotic consumption in DDDs per 1000 inhabitants, with 3 different scenarios for search-and-treat strategy for H. pylori. Note: Scenario 1: eradication limited to anybody reaching 18 years of age. Scenario 2: the age group 40–64 years invited for screen-and-treat within a 3-year period, 70% compliance. Scenario 3: all adults invited for screen-and-treat within a 3-year period, 70% compliance. Vertical axis: DDDs per 1000 inhabitants per day. Horizontal axis: years. Dotted line: the trend-line without intervention

Fig. 2

Potential overall consumption of antibacterials for systemic use (ATC group J01) in Latvia compared to other countries in the European Union/European Economic area, with the hypothetical scenarios of an H. pylori screen-and-treat strategy expressed as DDD per 1000 inhabitants per day. Note: The bars in blue indicate the current consumption of antibacterials (including Latvia). The bars in red are consumption of antibacterials in Latvia with various scenarios during the first year of a screen-and-treat strategy implementation. Scenario 1: eradication limited to anybody reaching 18 years of age. Scenario 2: the age group 40–64 years invited for screen-and-treat within a 3-year period; 70% compliance. Scenario 3: all adults invited for screen-and-treat within a 3-year period; 70% compliance