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Aliment Pharmacol Ther. 2016 Feb;43(4):514-33. doi: 10.1111/apt.13497. Epub 2015 Dec 23.

Review article: the global emergence of Helicobacter pylori antibiotic resistance.

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Division of Anatomic Pathology, Department of Pathology, University of California San Diego Medical Center, San Diego, CA, USA.
Division of Gastroenterology, Department of Medicine, University of California San Diego Medical Center, La Jolla, CA, USA.
Department of Pathology and the Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, TX, USA.



Helicobacter pylori is one of the most prevalent global pathogens and can lead to gastrointestinal disease including peptic ulcers, gastric marginal zone lymphoma and gastric carcinoma.


To review recent trends in H. pylori antibiotic resistance rates, and to discuss diagnostics and treatment paradigms.


A PubMed literature search using the following keywords: Helicobacter pylori, antibiotic resistance, clarithromycin, levofloxacin, metronidazole, prevalence, susceptibility testing.


The prevalence of bacterial antibiotic resistance is regionally variable and appears to be markedly increasing with time in many countries. Concordantly, the antimicrobial eradication rate of H. pylori has been declining globally. In particular, clarithromycin resistance has been rapidly increasing in many countries over the past decade, with rates as high as approximately 30% in Japan and Italy, 50% in China and 40% in Turkey; whereas resistance rates are much lower in Sweden and Taiwan, at approximately 15%; there are limited data in the USA. Other antibiotics show similar trends, although less pronounced.


Since the choice of empiric therapies should be predicated on accurate information regarding antibiotic resistance rates, there is a critical need for determination of current rates at a local scale, and perhaps in individual patients. Such information would not only guide selection of appropriate empiric antibiotic therapy but also inform the development of better methods to identify H. pylori antibiotic resistance at diagnosis. Patient-specific tailoring of effective antibiotic treatment strategies may lead to reduced treatment failures and less antibiotic resistance.

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