Modern rescue (salvage) therapies in the eradication of Helicobacter pylori: 2022–2025 update
Abstract
Research objective: The aim of this review is to comprehensively analyze modern rescue (salvage) therapy regimens used in the eradication of Helicobacter pylori after failure of standard treatments, with particular focus on advances published between 2022 and 2025, including novel antibiotic strategies, optimized acid suppression, and personalized therapeutic approaches.
Methodology: A narrative literature review was conducted based on clinical trials, randomized controlled studies, systematic reviews, meta-analyses, and international clinical guidelines published between 2022 and 2025, including the Maastricht VI/Florence Consensus, ACG Clinical Guidelines, WGO Global Guideline, and Chinese National Clinical Practice Guidelines. The review covers mechanisms of antibiotic resistance, treatment algorithms, and comparative efficacy and safety of selected rescue regimens.
Main conclusions: Rising antibiotic resistance — particularly to clarithromycin, levofloxacin, and metronidazole — has significantly reduced the effectiveness of standard eradication regimens. Bismuth-based quadruple therapy remains a cornerstone of rescue treatment, while vonoprazan-based regimens and high-dose dual therapy (HDDT) have demonstrated superior or non-inferior eradication rates compared to standard protocols. Rifabutin-based triple therapy offers a reliable option in refractory cases, and adjunctive probiotics reduce adverse effects associated with antibiotic therapy.
Application of the study:…
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