<i>Helicobacter pylori</i> antibiotic resistance: a global challenge in search of solutions
Christian Schulz, Jyh‐Ming Liou, Mohamed Alboraie, Jan Bornschein, Christian Campos Nuñez, Luiz Gonzaga Vaz Coelho, Duc Trong Quach, Carlo A Fallone, Yi‐Chu Chen, Markus Gerhard, Javier P. Gisbert, Hwoon‐Yong Jung, Peter Katelaris, Jae Gyu Kim, Hong Lü, Lukas Macke, Varocha Mahachai, Steven F. Moss, J.M. Remes-Troche, Arnoldo Riquelme, Marco Romano, Mashiko Setshedi, Stella Smith, Sebastian Suerbaum, Evariste Tshibangu‐Kabamba, Ratha‐Korn Vilaichone, Abbas Yadegar, Yoshio Yamaoka, Françis Mégraud, Emad El‐Omar, Kentaro Sugano, Peter Malfertheiner
Abstract
Background Helicobacter pylori resistance to antibiotics commonly used in eradication regimens is increasing dramatically in many locations; new strategies are needed to manage this infectious disease. Objective This study’s aim was to collect and update information on antibiotic resistance (AR) rates in H. pylori as well as current strategies for H. pylori management, including public health issues, from a global perspective. Design An international survey was conducted in 31 countries on 6 continents to address key issues concerning the management of H. pylori -related AR. Individual aspects included the prevalence of AR for specific antibiotics, antibiotic susceptibility testing (AST) in different healthcare systems, availability of drugs, reimbursement issues and strategies for H. pylori AR surveillance. Results Resistance to the most effective antibiotics used in H. pylori eradication regimens is increasing globally, with clarithromycin and levofloxacin resistance exceeding 15% in 24/31 and 18/31 countries, respectively. Amoxicillin remains an exception, with resistance rates under 2% in 14/31 countries; though African countries have reported amoxicillin resistance rates of over 90%. Bismuth-based treatment regimens are the most effective and are recommended as first-line treatment in several countries. However, more than 1 billion inhabitants worldwide have no access to bismuth-based regimens. PCR-based tests for AR are used in 16/26 countries but are reimbursed in only 4, while next generation sequencing-based tests are available, but not reimbursed, in 3 countries. In 22/26 countries only culture-based methods are available (reimbursed in 9/26 countries). AR surveillance programmes have only been established in 4/26 countries. Therefore, in most countries, empirical therapy with the most effective local regimen available locally is practiced. Conclusion The dramatic global rise in H. pylori antibiotic resistance requires an urgent revision of current management strategies. Possible solutions include AST-based selection of effective treatment regimens, identification of novel combinations of existing drugs and exploration of novel drugs.