Novel Approaches to the Treatment of Helicobacter Pylori Infection in the Era of Antibiotic Resistance

Abstract

Helicobacter pylori infection remains one of the most prevalent chronic bacterial diseases worldwide and a key etiological factor in peptic ulcer disease, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma. Despite the availability of established eradication regimens, the effectiveness of standard therapies has declined in recent years, primarily due to the growing prevalence of antibiotic-resistant strains, particularly to clarithromycin, metronidazole, and levofloxacin. This review analyzes contemporary treatment strategies for H. pylori infection with a focus on approaches that address antibiotic resistance. Current evidence supports the transition from empiric standard triple therapy to optimized regimens, including bismuth-based quadruple therapy, concomitant therapy, and tailored treatment guided by antimicrobial susceptibility testing where available. The role of novel acid suppression strategies, such as potassium-competitive acid blockers, is also considered, given their potential to enhance eradication rates by improving intragastric pH control. In addition, emerging therapeutic directions are discussed, including the use of rifabutin-based regimens, high-dose dual therapy, and adjunctive approaches aimed at improving treatment adherence and microbiological outcomes. The clinical implications of regional resistance patterns and the importance of individualized treatment selection are emphasized. A shift toward resistance-adapted and patient-specific strategies appears essential to maintain high eradication success rates. Future treatment algorithms should integrate local epidemiological data, optimize pharmacological combinations, and reduce unnecessary antibiotic exposure to limit further resistance development.