brand logo

Am Fam Physician. 2008;77(2):146

Author disclosure: Nothing to disclose.

to the editor: We read with interest the article, “Update on Helicobacter pylori Treatment” in the February 1, 2007, issue of American Family Physician.1 The authors give the “test-and-treat” strategy in the evaluation of patients with dyspepsia an evidence rating of A, stating that it reduces the use of endoscopies and antisecretory medications. This strategy will indeed reduce the number of endoscopies—at the cost of an increase in antibiotic prescriptions. Seventy-five percent of these prescriptions will be unnecessary, because only one out of every four treated patients will have peptic ulcers and thus benefit from antibiotic therapy.2 Therefore, the statement could instead be made that the “test-and-treat” strategy will lead to unnecessary antibiotic treatment in 75 percent of patients with dyspepsia.

The test-and-treat strategy risks unnecessary allergic reactions, antibiotic-associated diarrhea, and the development of antibiotic resistance. Assuming a prevalence of dyspepsia of about 25 percent in the adult U.S. population, with a yearly incidence of 7 percent,3,4 and a prevalence of H. pylori seropositivity ranging from 20 percent in younger patients to 50 percent in 45 to 55-year-olds,2 millions of unnecessary antibiotics would be prescribed every year. This would counteract the successful efforts to reduce antibiotic prescriptions for otitis media, bronchitis, and other viral infections.

Email letter submissions to afplet@aafp.org. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors. Letters submitted for publication in AFP must not be submitted to any other publication. Letters may be edited to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

Continue Reading


More in AFP

Copyright © 2008 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.