Sequential changes of antibiotic resistances of Helicobacter pylori in Taiwan from 2019 to 2024

doi:10.3748/wjg.v31.i39.111380

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Oct 21, 2025; 31(39): 111380
Published online Oct 21, 2025. doi: 10.3748/wjg.v31.i39.111380

Sequential changes of antibiotic resistances of Helicobacter pylori in Taiwan from 2019 to 2024

Pei-Jui Wu, Feng-Woei Tsay, Deng-Chyang Wu, Jyh-Chin Yang, Seng-Kee Chuah, Kuan-Yang Chen, Chien-Lin Chen, Chia-Long Lee, Chih-An Shih, Yu-Hwa Liu, Sz-Iuan Shiu, Wei-Chen Tai, Chao-Hung Kuo, Wei-Yi Lei, Sung-Shuo Kao, Tzung-Jiun Tsai, I-Che Feng, Mitsuhiro Koseki, Ping-I Hsu, Ming-Jen Sheu

Pei-Jui Wu, I-Che Feng, Mitsuhiro Koseki, Ming-Jen Sheu, Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan 71004, Taiwan

Feng-Woei Tsay, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaoshiung Veterans General Hospital, Kaohsiung 813414, Taiwan

Deng-Chyang Wu, Chao-Hung Kuo, Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807377, Taiwan

Jyh-Chin Yang, Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100229, Taiwan

Seng-Kee Chuah, Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833253, Taiwan

Kuan-Yang Chen, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei City Hospital, Taipei 10629, Taiwan

Chien-Lin Chen, Department of Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien 970473, Taiwan

Chia-Long Lee, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Cathay General Hospital, Taipei 10650, Taiwan

Chih-An Shih, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Antai Medical Care Corporation, Antai Tian-Sheng Memorial Hospital, Pingtung County 928, Taiwan

Yu-Hwa Liu, Division of Gastroenterology, Department of Internal Medicine, Shin Kong Wu Huo-Shih Memorial Hospital, Taipei 111045, Taiwan

Sz-Iuan Shiu, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan

Wei-Chen Tai, Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833253, Taiwan

Wei-Chen Tai, Department of Leisure and Sport Management, Cheng Shiu University, Kaohsiung 833253, Taiwan

Wei-Yi Lei, Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 970473, Taiwan

Sung-Shuo Kao, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 813414, Taiwan

Tzung-Jiun Tsai, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan

Ping-I Hsu, Division of Gastroenterology, Department of Internal Medicine, An Nan Hospital, China Medical University, Tainan 709204, Taiwan

Co-first authors: Pei-Jui Wu and Feng-Woei Tsay.

Co-corresponding authors: Ping-I Hsu and Ming-Jen Sheu.

Author contributions: Hsu PI, Sheu MJ designed and conducted the study; Wu PJ wrote the paper; Tsay FW contributed to the analysis and statistics; Wu DC, Yang JC provided clinical advice; Chuah SK, Chen KY, Chen CL, Lee CL, Shih CA, Liu YH, Shiu SI, Tai WC, Kuo CH, Lei WY, Kao SS, Tsai TJ, Feng IC, Koseki M provided clinical data; Hsu PI supervised the study; All authors discussed the results and contributed to the final manuscript; Wu PJ and Tsay FW contributed equally to this work as co-first authors; Hsu PI and Sheu MJ contributed equally to this work as co-corresponding authors.

Supported by the An Nan Hospital, China Medical University, No. ANHRF114-20 and No. ANHRF114-21.

Institutional review board statement: The study protocol was approved by the Institutional Review Board and the Ethics Committee of An Nan Hospital, No. TMANH109-REC002(AR-1) and No. TMANH109-REC025, and patient data were anonymized.

Informed consent statement: The requirement for informed consent was waived.

Conflict-of-interest statement: The research funding was provided by the An Nan Hospital.

Data sharing statement: Dataset available from the corresponding author at williamhsup@yahoo.com.tw.

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: Ping-I Hsu, MD, Professor, Division of Gastroenterology, Department of Internal Medicine, An Nan Hospital, China Medical University, No. 66, Sec. 2, Changhe Road, Tainan 709204, Taiwan. williamhsup@yahoo.com.tw

Received: July 1, 2025
Revised: August 2, 2025
Accepted: September 11, 2025
Published online: October 21, 2025
Processing time: 114 Days and 20.1 Hours

Abstract

BACKGROUND

Antibiotic resistance significantly impacts the treatment failure rates of Helicobacter pylori (H. pylori) infections.

AIM

To investigate the trends in primary antibiotic resistance of H. pylori in Taiwan over the past six years.

METHODS

We conducted a retrospective analysis of H. pylori isolates from Taiwanese who had not undergone previous treatments (n = 1408), collected between January 1, 2019 and December 31, 2024. Susceptibility of these strains to amoxicillin, clarithromycin, levofloxacin, metronidazole, and tetracycline was tested using the Epsilometer test. We analyzed the trends in single and dual resistance profiles over the study period, and compared antibiotic resistance across different regions (northern, southern and eastern areas) of Taiwan.

RESULTS

The overall resistance rates for H. pylori to amoxicillin, clarithromycin, metronidazole, tetracycline, and levofloxacin in Taiwan were 1.3%, 18.0%, 31.0%, 0.8%, and 28.7%, respectively. Tetracycline resistance increased significantly from 0% in 2019 to 3.5% in 2024 (P value in χ² test for linear trend: < 0.001), while metronidazole resistance declined from 35.5% to 13.0% (P value in χ² test for linear trend: < 0.001). No significant changes of amoxicillin, clarithromycin and levofloxacin resistances were observed. The dual resistances to clarithromycin plus tetracycline, and metronidazole plus tetracycline both increased significantly from 0% to 1.7% from 2019 to 2024 (P value in χ² test for linear trend: < 0.05). Furthermore, no significant regional differences in resistance frequencies except for levofloxacin were detected.

CONCLUSION

Primary antibiotic resistance to tetracycline in H. pylori has increased in Taiwan from 2019 to 2024, while resistance to metronidazole has decreased during the same period. The dual resistance to clarithromycin plus tetracycline and metronidazole plus tetracycline both increased significantly.

Keywords: Helicobacter pylori; Resistance; Antibiotic; Amoxicillin; Clarithromycin; Metronidazole; Tetracycline; Levofloxacin

Core Tip: Antibiotic resistance significantly impacts the treatment failure rates of Helicobacter pylori (H. pylori) infections. We analyzed the trends in single and dual resistance profiles of H. pylori treatment-naive Taiwanese between January 2019 and December 2024. Primary antibiotic resistance to tetracycline in H. pylori has increased in Taiwan from 2019 to 2024, while resistance to metronidazole have decreased during the same period. Additionally, the dual resistance to clarithromycin plus tetracycline and metronidazole plus tetracycline both increased significantly. These changes carry major clinical implications: It threatens the efficacy of bismuth-based quadruple therapy and limit the treatment options.