Multidrug resistance in Helicobacter pylori: current state and future directions

Area of Science:

• Microbiology
• Infectious Diseases
• Pharmacology

Background:

• Antibiotic resistance in Helicobacter pylori (H. pylori) is a growing global concern.
• Multidrug resistance (MDR) significantly compromises the effectiveness of H. pylori eradication therapies.
• Recent data indicate alarming rates of triple, quadruple, and even higher-order resistance.

Purpose of the Study:

• To review current H. pylori MDR rates, primarily based on literature published since 2015.
• To outline existing strategies and propose future directions for combating H. pylori MDR.
• To highlight the importance of strain susceptibility testing.

Main Methods:

• Systematic review of recent scientific literature (post-2015) on H. pylori MDR.
• Analysis of reported MDR prevalence data from various geographical regions.
• Synthesis of expert opinions on current and future therapeutic approaches.

Main Results:

• Primary MDR rates vary widely, from under 10% in Europe to over 40% in Peru.
• Post-treatment or overall MDR rates exceed 23-36% in approximately half of the reviewed studies.
• Factors contributing to MDR include antibiotic consumption, misuse, treatment failures, and bacterial mechanisms like mutations and biofilms.

Conclusions:

• Urgent optimization of eradication regimens and exploration of novel treatments are necessary.
• Wider use of bismuth-containing therapies, vonoprazan, new antibiotics, adjuvants (N-acetylcysteine, probiotics), anti-biofilm agents, and vaccines are promising avenues.
• Development of non-invasive resistance detection methods and increased implementation of strain susceptibility testing are critical for future H. pylori management.