Clinical Factors Implicated in Antibiotic Resistance in Helicobacter pylori Patients

Abstract

Helicobacter pylori is a common gastric pathogen associated with multiple clinical syndromes, including cancer. Eradication rates of H. pylori remain suboptimal despite the progress made in the past few decades in improving treatment strategies. The low eradication rates are mainly driven by antibiotic resistance of H. pylori. Non-invasive molecular testing to identify patients with antibiotic-resistant H. pylori represents a promising therapeutic avenue, however this technology currently remains limited by availability, costs, and lack of robust validation. Moreover, there is insufficient evidence to demonstrate that resistance-testing-based treatment approaches are superior to appropriately designed empiric strategies. Consensus guidelines recommend use of proven locally effective regimens; however, eradication data are inconsistently generated in several regions of the world. In this review, we describe several clinical factors associated with increased rates of antibiotic resistant H. pylori, including history of previous antibiotic exposure, increasing age, female gender, ethnicity/race, extent of alcohol use, and non-ulcer dyspepsia. Assessment of these factors may aid the clinician in choosing the most appropriate empiric treatment strategy for each patient. Future study should aim to identify locally effective therapies and further explore the clinical factors associated with antibiotic resistance.

Comparative Study of Helicobacter Pylori Resistance to Clarithromycin and Metronidazole and Its Association with Epidemiological Factors in A Moroccan Population

“…Also, in a Korean study, they didn't find a relationship between the prevalence of metronidazole resistance and age (Lee et al, 2013). In contrast, metronidazole resistance was significantly associated with age in an American and Japanese studies (Okuda et al, 2019;White et al, 2022).…”

Current guidelines for Helicobacter pylori treatment in East Asia 2022: Differences among China, Japan, and South Korea

“…A recent nationwide study demonstrated that the H. pylori eradication rate of concomitant therapy is significantly higher than that of sequential therapy (91.8% vs 86.1%, P < 0.001)[ 54 ]. Antibiotic overuse and the emergence of multidrug-resistant H. pylori may be problematic for concomitant therapy[ 55 ].…”

Clinical Implications of Helicobacter pylori Antibiotic Resistance in Italy: A Review of the Literature

“…Several clinical factors have been associated with antibiotic-resistant H. pylori , including previous antibiotic exposure, older age, female sex, geographic region, ethnicity, alcohol consumption, and non-ulcer dyspepsia [ 63 ]. However, the most important risk factor associated with antibiotic resistance is previous antibiotic use [ 64 ].…”

“…Furthermore, antibiotic resistance to H. pylori can vary between ethnic groups even in the same geographic area, suggesting differences in access to healthcare and the presence of genetic and cultural factors [ 63 ].…”