Best Helicobacter pylori Eradication Strategy in the Era of Antibiotic Resistance

Abstract

Antibiotic resistance is the major reason for Helicobacter pylori treatment failure, and the increasing frequency of antibiotic resistance is a challenge for clinicians. Resistance to clarithromycin and metronidazole is a particular problem. The standard triple therapy (proton pump inhibitor, amoxicillin, and clarithromycin) is no longer appropriate as the first-line treatment in most areas. Recent guidelines for the treatment of H. pylori infection recommend a quadruple regimen (bismuth or non-bismuth) as the first-line therapy. This treatment strategy is effective for areas with high resistance to clarithromycin or metronidazole, but the resistance rate inevitably increases as a result of prolonged therapy with multiple antibiotics. Novel potassium-competitive acid blocker-based therapy may be effective, but the data are limited. Tailored therapy based on antimicrobial susceptibility test results is ideal. This review discussed the current important regimens for H. pylori treatment and the optimum H. pylori eradication strategy.

Revisiting Therapeutic Strategies for H. pylori Treatment in the Context of Antibiotic Resistance: Focus on Alternative and Complementary Therapies

“…Most infected subjects remain asymptomatic for a long time, but this colonization produces a silent destruction of the gastric mucosa. Since its discovery in 1982, by Australian doctors Barry Marshall and Robin Warren, more and more studies have proven that H. pylori is responsible for atrophic gastritis, peptic ulcer, and gastric malignancies [ 1 , 2 ]. From a physiological point of view, H. pylori is microaerophilic, requiring oxygen to survive, but at a lower concentration than in the atmosphere.…”

Antibiofilm and Antimicrobial-Enhancing Activity of Chelidonium majus and Corydalis cheilanthifolia Extracts against Multidrug-Resistant Helicobacter pylori

“…The results of this European study are consistent with both world-level [ 6 ] and national-level data published by our team [ 7 ]. Therefore, attention should be paid to the maintenance of an appropriate degree of H. pylori eradication and development of alternative, effective methods for combating this pathogen [ 8 , 9 , 10 ].…”

Efficiency of Diagnostic Testing for Helicobacter pylori Infections—A Systematic Review

“…It has been reported that QCT may overcome the declining H. pylori eradication rate [ 20 ]. Although quadruple-regimen therapy (bismuth or non-bismuth) has been reported to be useful when resistance to clarithromycin or metronidazole is present, it also increases resistance if treatment is prolonged with multiple antibiotics [ 21 ].…”

“…The worrying evolution of the increase in AMR, including primary resistance, has generated a growing international consensus on the importance of tailored therapy through analysis of susceptibility prior to the initiation of treatment for H. pylori infection [ 6 , 21 , 22 ]. However, susceptibility testing is not commonly performed [ 22 ].…”