Persistent Helicobacter pylori Infection: An Insight to the Limitations of Current Clinical Practice

The discovery of the pathological role of Helicobacter pylori in various disease states, such as peptic ulcer disease (PUD) and Mucosa Associated Lymphoid Tissue (MALT) lymphoma, was ground-breaking in the field of gastroenterology. Given the potentially dire clinical implications of chronic H. pylori infection, it is important to achieve complete eradication. More importantly, the rising prevalence of H. pylori antimicrobial resistance, similar to other pathogens world-wide, is of particular concern. Despite evidence supporting the growing threat of antimicrobial resistance, clinically, it is also important to survey just how much of the failed treatment is truly a reflection of resistance versus poor treatment adherence. In this report, we detail the case of a 64-year-old female who was previously given six treatment courses for persistent H. pylori infection. Successful eradication was achieved with rifabutin triple therapy consisting of high-dose amoxicillin and strict adherence monitoring by a clinical pharmacist. This case highlights the importance of patient education, medication reconciliation, and close monitoring to ensure successful treatment of persistent H. pylori infection.