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.
Highlights
Helicobacter pylori is a ubiquitous microorganism infecting an estimated 50% of adults worldwide [1]
Research predict which patients tion, previous useresistance of antibioticsthat suchmay as clarithromycin, cephalexin for anyto infection decreased the chance of eradication, while past use of Pump Inhibitors (PPIs), metronidazole and tetracycline are at increased risk of treatment failure and subsequently guide the selection of successful increased the chances of eradication
Antibiotic resistance is one of multiple factors implicated in H. pylori treatment failure, along with comorbidities such as diabetes mellitus, cigarette smoking, CYP2C19 metabolizer genotype, and non-adherence to therapy; it remains the most significant [74,75,76,77]
Summary
Helicobacter pylori is a ubiquitous microorganism infecting an estimated 50% of adults worldwide [1]. Research predict which patients tion, previous useresistance of antibioticsthat suchmay as clarithromycin, cephalexin for anyto infection decreased the chance of eradication, while past use of PPI, metronidazole and tetracycline are at increased risk of treatment failure and subsequently guide the selection of successful increased the chances of eradication These results suggest that the clinical history may and cost-effective personalized empiric therapy. Pylori isolates from patients with active or inactive peptic ulcer predict which patients are at increased risk of treatment failure and subsequently guide the selection of successful andmultiple cost‐effective personalized empiric therapy They identified risk factors for resistance to clarithromycin and metronMeyerincluding et al [25] carried out meta‐analysis of 20 US trials conducted idazole, geographic region, older age, female sex,between inactive ulcer disease, and and 1999 that tested H. pylori isolates from patients with active or inactive peptic ulcer.
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