A systematic review on Helicobacter pylori antimicrobial resistance: Global trends, clinical implications, and future strategies
Abstract
Objective: Helicobacter pylori remains one of the most prevalent bacterial infections globally. While H. pylori eradication reduces gastric cancer risk, increasing antimicrobial resistance (AMR) impairs the effective treatment with major geographic variability. This systematic review summarizes the global epidemiology, mechanisms of resistance, clinical consequences, and emerging strategies to address H. pylori AMR. Materials and Methods: We systematically searched PubMed, Scopus, and Web of Science for articles published between 2000 and June 2025. Keywords included “Helicobacter pylori”, “antimicrobial resistance”, “clarithromycin”, “metronidazole”, “levofloxacin”, “children”, and “epidemiology”. Inclusion criteria comprised English-language studies in human subjects reporting prevalence, mechanisms, or treatment outcomes related to resistance. Excluded were case reports, animal studies, and small series (<20 patients). Emphasis was placed on multicenter trials, surveillance reports, and systematic reviews. Results: Analysis of included studies demonstrated that clarithromycin resistance exceeds 20-30% in many regions, particularly East Asia and Southern Europe, undermining traditional triple therapy. Metronidazole resistance is widespread, ranging from 30-70% globally, while levofloxacin resistance shows alarming upward trends. Amoxicillin and tetracycline resistance remain rare, while rifabutin retains activity against multidrug-resistant strains. Pediatric populations…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 20 participants or records.
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