Treatment of Helicobacter pylori infection: Meeting the challenge of antimicrobial resistance

Core Tip

Core tip: Rising clarithromycin resistance has accounted for a dramatic decline in the efficacy of standard therapies for Helicobacter pylori (H. pylori) infection. Bismuth-quadruple, sequential, non-bismuth quadruple (concomitant), dual-concomitant (hybrid), and levofloxacin-based regimens are now recommended as preferred empirical treatments (> 90% efficacy). However, empiric treatment of H. pylori is likely to become more challenging as even these improved regimens are prone to the effect of antibiotic resistance. Individualized therapy appears as a reasonable future alternative, currently limited by the shortcomings of performing culture. Advances in the genotypic characterization of H. pylori therapeutic susceptibility are likely to revolutionize our approach to tailored treatment.