Helicobacter pylori (H. pylori) is a common gastrointestinal bacterial strain closely associated with the incidence of chronic
gastritis,
peptic ulcers, gastric mucosa-associated lymphoid tissue
lymphoma, and
gastric cancer. A current research and clinical challenge is the increased rate of antibiotic resistance in H. pylori, which has led to a decreased H. pylori eradication rate. In this article, we review recent H. pylori
infection and
reinfection rates and H. pylori resistance to
antibiotics, and we discuss the pertinent treatments. A PubMed literature search was performed using the following keywords: Helicobacter pylori,
infection,
reinfection, antibiotic resistance,
bismuth,
proton pump inhibitors,
vonoprazan, susceptibility, quintuple
therapy, dual
therapy, and probiotic. The prevalence of H. pylori has remained high in some areas despite the decreasing trend of H. pylori prevalence observed over time. Additionally, the H. pylori
reinfection rate has varied in different countries due to socioeconomic and hygienic conditions. Helicobacter pylori monoresistance to
clarithromycin,
metronidazole or
levofloxacin was common in most countries. However, the prevalence of
amoxicillin and tetracycline resistance has remained low. Because H. pylori
infection and
reinfection present serious challenges and because H. pylori resistance to
clarithromycin,
metronidazole or
levofloxacin remains high in most countries, the selection of an efficient regimen to eradicate H. pylori is critical. Currently,
bismuth-containing quadruple
therapies still achieve high eradication rates. Moreover, susceptibility-based
therapies are alternatives because they may avoid the use of unnecessary
antibiotics. Novel regimens, e.g.,
vonoprazan-containing triple
therapies, quintuple
therapies, high-dose dual
therapies, and standard triple
therapies with probiotics, require further studies concerning their efficiency and safety for treating H. pylori.