Helicobacter pylori (H. pylori) infection represents a major global health challenge and a leading cause of peptic ulcer disease and gastric cancer. The increasing prevalence of antimicrobial resistance has progressively reduced the effectiveness of traditional empirical eradication regimens, highlighting the need for more individualized treatment approaches. This review evaluates the evolving transition from empirical therapy toward precision-guided H. pylori management by integrating current evidence on resistance epidemiology, determinants of eradication failure, advances in molecular diagnostics, and susceptibility-guided treatment strategies. Contemporary and emerging therapeutic approaches are evaluated in the context of changing resistance patterns, with emphasis on their clinical applicability and potential contributions to treatment optimization. The review also addresses the practical challenges that continue to limit implementation of personalized management, including restricted access to resistance testing, infrastructure limitations, economic constraints, and global disparities in healthcare resources. Furthermore, emerging developments in rapid diagnostics, resistance surveillance, and data-driven treatment selection are considered as components of future management frameworks. Overall, the evidence supports moving away from one-size-fits-all empirical therapy toward targeted treatment based on local resistance patterns and epidemiological trends. Expanding access to effective diagnostics and optimizing treatment selection will be essential for improving eradication outcomes and preserving the long-term effectiveness of available antimicrobial agents.
Background/Objectives: Tuberculosis remains a major public health challenge due to the persistence of Mycobacterium tuberculosis (Mtb) and the emergence of multidrug-resistant strains. In this study, Pep-H, an HNP-1-derived antimicrobial peptide with the sequence RRYGTCIYQGRLWAF-NH2, was used as a compact scaffold to examine how single-residue substitutions at the Cys position affected its biological and functional profile. Methods: A focused single-position substitution panel was generated by replacing Cys with Trp, Ala, Arg, or Met while preserving peptide length and sequence context, and the analogs were computationally prioritized according to their predicted antitubercular potential and contrasting side-chain properties. The peptides were synthesized, purified, characterized by HPLC and mass spectrometry, and evaluated for activity against Mtb H37Rv, cytotoxicity, hemolysis, ethidium bromide accumulation, and DPPH radical scavenging. Results: Pep-H retained the most favorable profile, showing the highest antimycobacterial potency, low hemolysis, favorable selectivity indices, enhanced ethidium bromide accumulation, and the strongest antioxidant response. All Cys substitutions reduced antimycobacterial activity, indicating that none of the tested residues reproduced the integrated biological profile of Pep-H. Conclusions: The contrasting outcomes of the Arg- and Met-containing analogs suggest that increased cationicity or sulfur retention alone was insufficient, while supporting a multifactorial contribution of Cys side-chain chemistry and the local GTCIY environment.
BACKGROUND:While equine patient-mediated introduction of A. baumannii into hospital settings has been documented, its environmental dissemination and the risk of hospital-acquired surgical site infection remain poorly understood. OBJECTIVE:Therefore, this descriptive observational study examined (a) the environmental distribution of Acinetobacter spp. in an equine university hospital, (b) the impact of the implementation of new hygiene protocols, (c) the specification of resistance patterns, and (d) the evaluation of the presence of Acinetobacter spp. in hospital-acquired wound infections. METHODS:During three sampling periods, environmental samples of the stables, the treatment, and surgery areas were collected before and after cleaning and disinfection. After sampling period 1 (December 2021), the cleaning routines were optimized by reviewing the cleaning and disinfection process, as well as including further surfaces in the cleaning schedule for January 2022). This was followed by a second (February 2022) and a third (June 2022) sampling period. During sampling periods 1 and 2, 76 surfaces were sampled; in sampling period 3, only 21 critical surfaces were examined. Samples were cultured on selective agar plates and incubated at 37 °C, with bacterial growth evaluated after 24-48 h. Wound swabs were enriched in broth before culturing. Bacteria were identified using MALDI-TOF mass spectrometry. During the first sampling period, antibiotic susceptibility testing was performed using broth microdilution according to CLSI-vet standards. RESULTS:During each sampling period, Acinetobacter spp. was detected in at least one sample in each of the different areas; however, there was a reduced detection rate from sampling period 1 throughout sampling period 3. The isolates were highly resistant against beta-lactam and macrolide antibiotics but mostly sensitive to fluroquinolones (enrofloxacin, 2.2% resistance; marbofloxacin, 0.0% resistance), aminoglycosides (gentamicin, 6.5% resistance; kanamycin, 8.7% resistance), and tetracyclines. Acinetobacter spp. was not detected in surgical site infections. CONCLUSIONS:Environmental persistence of Acinetobacter spp. in an equine clinical setting does not necessarily translate into surgical site infections. Through prudent antibiotic use, the antibiotic susceptibility of the isolates may be perceived.
Background/Objectives: Inappropriate antibiotic prescribing in primary healthcare (PHC) contributes to bacterial antimicrobial resistance (AMR). Antibiotic stewardship, including measuring the appropriateness of antibiotic prescribing using quality indicators, is a priority in PHC where most antibiotics are used. Using previously developed WHO AWaRe classification-based quality indicators, we aim to test the clinimetric properties of 13 acute respiratory tract infection (RTI) quality indicators and qualitatively explore factors influencing PHC antibiotic prescribing in South Africa. Methods: We conducted a mixed-methods exploratory feasibility study using point prevalence surveys (PPSs) with clinimetric assessment and prescriber interviews. PPSs were conducted at four PHC facilities in Gauteng province that had taken part in previous PPS studies, alongside face-to-face interviews with PHC personnel. Results: In total, 52/52 (100%) RTI patients received antibiotics. Four (30.8%) indicators achieved scores above 85%, while six (46.2%) scored below 50%. All indicators had applicability scores ≥10%. Twelve (92.3%) indicators had a measurability score of 100%, while one (7.7%) had a measurability score <75%. Twelve (92.3%) indicators met all predefined acceptable scores for applicability and measurability. No participant knew of the WHO's AWaRe classification and none had specific training on antibiotic prescribing and AMR. They also had no antibiotic stewardship programmes (ASPs) or specific antibiotic-prescribing guidelines at their facilities. Key factors affecting antibiotic prescribing included shortages, patient expectations and fear of complications. Conclusions: The indicators demonstrated acceptable clinimetric properties in South Africa. Robust locally validated indicators, combined with ASPs promoting the AWaRe classification, are imperative for accurate assessment and improvement of antibiotic prescribing.
Background: Antimicrobial resistance (AMR) is a growing global health threat, disproportionately affecting low- and middle-income countries such as Sudan. Conflict-related health system disruption has further intensified inappropriate antibiotic use and weakened stewardship capacity. Objective: This narrative review synthesizes contemporary evidence on antibiotic prescribing practices in Sudan, with emphasis on ambulatory care, and examines their implications for AMR control in the context of ongoing conflict. Methods: A non-systematic, structured narrative review was conducted successfully. PubMed, Google Scholar, WHO/EMRO databases, and Sudan’s National Action Plan (NAP) materials were examined for literature published between January 2010 and December 2025. Peer-reviewed research, government guidelines, surveillance reports, and gray literature were among the eligible sources. A total of 78 studies were included after titles, abstracts, and full texts were screened. Two reviewers independently confirmed the data extraction, and the synthesis aligned with SANRA guidelines. Results: Antibiotic prescribing in Sudan is frequently inappropriate, particularly in ambulatory and community settings, where empirical treatment, polypharmacy, and extensive use of Watch antibiotics are common. Alignment with WHO AWaRe recommendations remains suboptimal. Recent clinical and molecular evidence demonstrates increasing multidrug resistance among Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus, including ESBL production and emerging carbapenemase genes (e.g., NDM 1, IMP 1). Conflict-related disruptions—such as reduced laboratory capacity, supply chain breakdown, and unregulated community dispensing—have further accelerated AMR. Pilot stewardship interventions show promise but remain limited in scale. Conclusions: Inappropriate antibiotic use in Sudan is driven largely by ambulatory and community practices and has been exacerbated by conflict. Strengthening stewardship beyond hospitals, enforcing prescription-only regulations, operationalizing the AWaRe framework, and aligning empirical therapy with local resistance patterns are critical for mitigating AMR in Sudan and similar conflict-affected settings.
