A review on prevalence and genetic elements associated with antibiotic resistance of H. pylori: a narrative review
Abstract
Background: The management of Helicobacter pylori infection has become increasingly complex due to the global rise in antibiotic resistance, which undermines the effectiveness of conventional eradication regimens. This resistance is largely driven by inappropriate antibiotic use and regional variations in prescribing practices. Understanding the mechanisms and trends of resistance is crucial to designing effective, locally adapted treatment strategies. Objective: This review aimed to analyze global trends in H. pylori antibiotic resistance and identify genetic determinants associated with antimicrobial resistance to commonly used antibiotics, including amoxicillin, metronidazole, clarithromycin, levofloxacin, and tetracycline. Main Discussion Points: Evidence from multiple countries indicates a significant rise in resistance to several antibiotics, with metronidazole resistance reaching up to 100% in India and clarithromycin and tetracycline resistance rates exceeding 90% in some regions. Levofloxacin resistance remained relatively lower but showed a progressive increase in East Asia. Multidrug resistance, particularly the combination of metronidazole and clarithromycin, was notably high in Korea (40.3%). Genetic studies revealed key mutations responsible for resistance: A2143G in the 23S rRNA gene for clarithromycin, amino acid substitutions in the PBP1A gene for amoxicillin, mutations in the 16S rRNA gene for tetracycline, gyrA/gyrB substitutions for levofloxacin, and…
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