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Risk Factors for Helicobacter pylori Resistance
- Thomas W. Hennessy, MD, MPH;
- Brian J. McMahon, MD; and
- Jay C. Butler, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
IN RESPONSE:
We agree that the SHARP study (1) was useful for establishing the prevalence of antimicrobial resistance among H. pylori in the United States. However, the SHARP analysis did not include the most important determinant of antimicrobial resistance: an individual's antimicrobial use. Therefore, we believe the factors associated with antimicrobial-resistant H. pylori in the SHARP study are useful for hypothesis generation, but their value for clinical decision making is highly suspect. The factors cited by Drs. Seow and Chew are likely to be markers for patients with higher antimicrobial use. For example, the higher frequency of metronidazole-resistant H. pylori infection among women is explained in our study by higher rates of metronidazole use. In addition, it is unclear how to apply Drs. Seow and Chew's recommendation of using multiple risk factors to assess the risk for antimicrobial-resistant infection when those risk factors are contradictory, as would be the case for a person of low-risk ethnicity living in a high-risk geographic region. We believe that until antimicrobial susceptibility testing becomes more readily available for clinical use, past antimicrobial use will remain the simplest and most reliable means of assessing the risk for metronidazole- or clarithromycin-resistant H. pylori.
Thomas W. Hennessy, MD, MPH
Brian J. McMahon, MD
Jay C. Butler, MD
Centers for Disease Control and Prevention; Anchorage, AK 99508
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
