Helicobacter pylori INFECTION AMIDST ESCALATING ANTIMICROBIAL RESISTANCE: WHAT LIES AHEAD?

Abstract

Helicobacter pylori (H. pylori) is the most common worldwide gastric pathogen, which is associated with chronic gastritis, peptic ulcer disease and gastric cancer. Whilst having being subject to decades of therapeutic interventions, eradication is still elusive in the face of rising levels of antimicrobial resistance (AMR) like any other part of the world and much worse in the LMI countries. This review discusses the biology, pathogenesis, and clinical interpretation of H. pylori infection, highlighting the worldwide epidemiology, its transmission dynamics and the intricate immune response it induces. In addition, the review summarizes H. pylori immune evasion and acquisition of resistance to the first-line antibiotics, including clarithromycin and metronidazole, thus leading to the failure of the standard triple therapy. The effectiveness and tolerability of various treatment options, such as quadruple, concomitant, sequential, and dual therapies, are evaluated. The rising misuse of over-the-counter antibiotics and the bacterium’s adaptive transformations from bacillus to coccoid forms further complicate treatment. Emerging approaches, including the use of probiotics, novel acid suppressants, as well as the search for potent vaccine candidates are discussed as potential solutions to overcome AMR and achieve lasting eradication.

Keywords: Helicobacter pylori, Antimicrobial resistance, gastritis