Helicobacter pylori and Antibiotic Resistance, A Continuing and Intractable Problem

Abstract

Helicobacter pylori, a human pathogen with a high global prevalence, is the causative pathogen for multiple gastrointestinal diseases, especially chronic gastritis, peptic ulcers, gastric mucosa-associated lymphoid tissue lymphoma, and gastric malignancies. Antibiotic therapies remain the mainstay for H. pylori eradication; however, this strategy is hampered by the emergence and spread of H. pylori antibiotic resistance. Exploring the mechanistic basis of this resistance is becoming one of the major research questions in contemporary biomedical research, as such knowledge could be exploited to devise novel rational avenues for counteracting the existing resistance and devising strategies to avoid the development of a novel anti-H. pylori medication. Encouragingly, important progress in this field has been made recently. Here, we attempt to review the current state and progress with respect to the molecular mechanism of antibiotic resistance for H. pylori. A picture is emerging in which mutations of various genes in H. pylori, resulting in decreased membrane permeability, altered oxidation-reduction potential, and a more efficient efflux pump system. The increased knowledge on these mechanisms produces hope that antibiotic resistance in H. pylori can ultimately be countered.

In VitroandIn VivoAntibacterial Activities of Patchouli Alcohol, a Naturally Occurring Tricyclic Sesquiterpene, against Helicobacter pylori Infection

“…Owing to the antibiotic resistance and declining eradication rate of H. pylori in the clinic, more alternative therapeutic protocols are urgently necessary (20). In the present study, we aimed to investigate the anti-H. pylori activity and mechanism of PA.…”

Importance of antimicrobial susceptibility testing for the management of eradication inHelicobacter pyloriinfection

“…More importantly, it is also linked to gastric adenocarcinoma (0.1%-3%) and gastric mucosa-associated lymphoid tissue (MALT) lymphoma (< 0.01%) in infected individuals[6-11]. H. pylori is defined as a Class I carcinogen by the World Health Organization and the International Agency for Research on Cancer[6,8,10]. In addition to gastrointestinal disorders, H. pylori also plays a role in extradigestive diseases, including immune thrombocytopenic purpura, unexplained iron deficiency anaemia, and vitamin B12 deficiency.…”

Comparative Study of Clarithromycin- versus Metronidazole-Based Triple Therapy as First-Line Eradication for <b><i>Helicobacter pylori</i></b>

“…Although the eradication rate achieved using this first-line regimen was reported to be around 90% in 2001, the rate decreased to less than 80% by 2014 [13,15] . The progressive increase in the incidence of CAM-resistant H. pylori strains is considered to be responsible for the decline in the eradication rate [16,17] . In this prospective randomized study, we compared the efficacy of EAM with that of EAC.…”

“…Although a multicenter study conducted in 2001 reported that the eradication rate using first-line therapy was around 90%, the rate decreased to 70-80% in 2014 [13,15] . A possible explanation for the decreased eradication rate is the prevalence of CAM-resistant H. pylori in Japan [16,17] . Okamura et al [16] reported that the rate of CAM resistance is above 30 and 50% in old and young patients, respectively.…”