The spiral shaped Gram-negative bacterium, Helicobacter pylori colonizes the stomach of more than 50% of the world's population and can persist for a lifetime if not completely eradicated. High prevalence of the bacterium is common in most population although a majority of the infected patients remain asymptomatic; with only a small subset of infected people experiencing H. pylori-associated illnesses such as chronic gastritis, gastric and duodenal ulcers, mucosa associated lymphoid tissue lymphoma as well as adenocarcinoma. H. pylori is common in South Africa with prevalence ranging from 50 -84% as depicted in the various studies conducted across the country. Infection is usually acquired in childhood and is associated with low socio-economic status, overcrowding, poor sanitation and unclean water supplies which appear to influence the rate of transmission. Eradication of this pathogen is a global challenge due to its alarming rate of drug resistance. Triple therapy consisting of a proton pump inhibitor and clarithromycin and either metronidazole or amoxicillin, is recommended for treatment. In this article, we review the major studies conducted based on H. pylori prevalence, epidemiology and antimicrobial chemotherapy in South Africa. Overall, the results of the findings indicate a high prevalence of H. pylori, resistance to recommended therapy and identified the need to consider natural products, including medicinal plants and honey as leads, which may offer useful alternatives in the treatment of H. pylori-related infections in South Africa and the world at large.

Helicobacter pylori are gram negative spiral bacteria that colonize the human stomach. Infection with H. pylori is associated with chronic gastritis, peptic ulcer, gastric adenocarcinoma and gastric mucosaassociated lymphoid tissue (MALT) lymphoma. Antibiotic resistance is an ever increasing problem with the treatment of most microbial infections including H. pylori; and has become a growing problem worldwide with the eradication of this organism. In recent years, several treatment regimens have been proposed for H. pylori eradication. However, the only conditions for which such treatment is strongly recommended on the basis of unequivocal supporting evidence are peptic ulcer disease and low grade gastric MALT lymphoma. Success of antimicrobial regimens for H. pylori eradication depends on patient compliance and lack of antimicrobial resistance. Metronidazole (Mtz) containing regimens have been shown to limit effectiveness because of increasing prevalence of resistance to this drug. A high prevalence (> 90%) of Mtz resistance in H. pylori has been reported especially in developing countries. Mtz resistance may be mediated through an inability of Mtz-resistant strains to remove oxygen from the site of Mtz reduction, thereby preventing Mtz activation. This has been attributed to a mutation on the frxA and/or rdxA genes resulting in strains of the organism with defective nitro-reductases coded by these genes. Infection by Mtz or amoxicillin resistant strains is an important factor leading to treatment failure; subjecting all H. pylori clinical isolates to susceptibility testing most especially to Mtz is recommended. If not possible, a program to survey the prevalence of resistance should be implemented in a given area or population. This increasing emergence of antimicrobial resistance in H. pylori treatment posses serious public health problems and is therefore necessary that new drug regimens be examined.