Rocha GR, Lemos FFB, Silva LGO, Luz MS, Correa Santos GL, Rocha Pinheiro SL, Calmon MS, de Melo FF. Overcoming antibiotic-resistant Helicobacter pylori infection: Current challenges and emerging approaches. World J Gastroenterol 2025; 31(10): 102289 [DOI: 10.3748/wjg.v31.i10.102289]
Corresponding Author of This Article
Fabrício Freire de Melo, PhD, Professor, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Rua Hormindo Barros, 58, Quadra 17, Lote 58, Vitória da Conquista 45029-094, Bahia, Brazil. freiremeloufba@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Mar 14, 2025; 31(10): 102289 Published online Mar 14, 2025. doi: 10.3748/wjg.v31.i10.102289
Overcoming antibiotic-resistant Helicobacter pylori infection: Current challenges and emerging approaches
Gabriel Reis Rocha, Fabian Fellipe Bueno Lemos, Luis Guilherme de Oliveira Silva, Marcel Silva Luz, Gabriel Lima Correa Santos, Samuel Luca Rocha Pinheiro, Mariana Santos Calmon, Fabrício Freire de Melo
Gabriel Reis Rocha, Fabian Fellipe Bueno Lemos, Luis Guilherme de Oliveira Silva, Marcel Silva Luz, Gabriel Lima Correa Santos, Samuel Luca Rocha Pinheiro, Mariana Santos Calmon, Fabrício Freire de Melo, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
Author contributions: Rocha GR, Lemos FFB, and de Melo FF contributed to the conceptualization of the manuscript; Rocha GR, Lemos FFB, Silva LGO, Luz MS, Correa Santos GL, Correa Santos GL, Rocha Pinheiro SL, and Calmon MS contributed to the investigation and wrote the original draft; Rocha GR and Silva LGO developed the tables and figures; Rocha GR and de Melo FF were responsible for manuscript editing and review; de Melo FF supervised the writing of the original draft.
Supported by the Industrial Technological Initiation Scholarship of National Council for Scientific and Technological Development, CNPq, Brazil, No. 0932204294929829 and No. 7414780530977345; the Scientific Initiation Scholarship Programme (PIBIC) of National Council for Scientific and Technological Development, CNPq, Brazil, No. 5763023359532159, No. 6472982965854452, and No. 7340128440641417; the Scientific Initiation Scholarship Programme (PIBIC) of Bahia State Research Support Foundation, FAPESB, Brazil, No. 19.573.301.5418; the PERMANECER Programme of Pro-Rectory of Student Assistance at Federal University of Bahia, No. R8EZ-4V4W-6LQX-5LC8; and the CNPq Research Productivity Fellow, No. 4357511882624145.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fabrício Freire de Melo, PhD, Professor, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Rua Hormindo Barros, 58, Quadra 17, Lote 58, Vitória da Conquista 45029-094, Bahia, Brazil. freiremeloufba@gmail.com
Received: October 13, 2024 Revised: November 28, 2024 Accepted: January 17, 2025 Published online: March 14, 2025 Processing time: 135 Days and 5.6 Hours
Abstract
Recent studies have shown a noticeable increase in global Helicobacter pylori(H. pylori) resistance, with clarithromycin resistance surpassing 15% in various areas. However, inadequate epidemiological monitoring, especially in developing countries, and the absence of uniform testing methods lead to discrepancies between regions and a possible underestimation of resistance levels. The complexity of treating H. pylori is driven by its highly dynamic genome, which is prone to frequent mutations contributing to phenotypical resistance. The usual course of action in empirical treatment involves using a combination of various drugs simultaneously, leading to significant resistance selection pressure and potential side effects. The emergence of H. pylori strains resistant to multiple drugs is closely tied to failures in first-line treatment, highlighting the need to prevent further resistance by using optimal initial empirical therapy or regimens guided by antibiotic susceptibility testing, requiring a collection of mixed samples and multiple isolates for accurate assessment. The emergence of new treatments like potassium-competitive acid blockers offers a hopeful approach to decrease antimicrobial usage while still ensuring effectiveness in comparison to traditional therapies with proton pump inhibitors. Additionally, the use of probiotics is under investigation to identify specific strains and formulations that may mitigate therapy-associated adverse effects.
Core Tip: The rise of antibiotic resistance in Helicobacter pylori (H. pylori) has become a global concern and led to the reduction of efficacy of conventional therapies. Resistant H. pylori strains, often inadequately mapped by regional surveillance, frequently demand multiple eradication attempts, imposing considerable financial burdens and adverse effects and contributing to secondary resistance development. This study aimed to provide a comprehensive review of the current landscape of mechanisms and prevalence of H. pylori resistance and to summarize promising therapeutic alternatives under evaluation. These strategies might improve treatment efficacy, enhancing patient outcomes in this challenging scenario.
