Evolution of Helicobacter pylori Resistance to Antibiotics: A Topic of Increasing Concern

Abstract

Antibiotic resistance among Helicobacter pylori strains is the major cause of eradication failure. Resistance prevalence is dynamic and can greatly vary among countries over the years. We revealed H. pylori resistance trends for five antibiotics in 14 countries through articles predominantly published in 2018-2022, since the latest data can best show the most recent trends in resistance evolution. Amoxicillin resistance generally exhibited no evolution, yet it increased in Bulgaria, Iran, China, and Vietnam. Metronidazole resistance exhibited different trends, including an increase, a decrease and no evolution in six, three, and five studies, respectively. Clarithromycin resistance increased in Australia, Belgium, Bulgaria, Italy, Iran, and Taiwan, but remained stable in France, Spain, Russia, China, Chile, and Colombia. Tetracycline resistance was low and stable except in Iran. Levofloxacin resistance increased in four European and six other countries/regions, without significant increases in France, Spain, and Chile. In Chile, triple resistance also increased. In countries such as France and Spain, resistance to most antibiotics was stabilized, while in Bulgaria, Belgium, Iran and Taiwan, resistance to three or more agents was reported. Use of non-recommended regimens, national antibiotic consumption, patient's compliance, host factors, strain virulence, migrations, and azithromycin overuse during the COVID-19 pandemic can influence resistance evolution. New drugs, eradication regimens and diagnostic methods, such as next-generation sequencing can improve H. pylori infection control.

Keywords: Helicobacter pylori; amoxicillin; antibiotic; clarithromycin; evolution; increase; levofloxacin; metronidazole; resistance; tetracycline.

Figure 1

The countries from which data are included. The map is taken from the website: https://www.freepik.com/free-vector/earth-map-linear-composition_9386670.htm (accessed on 10 January 2023). The countries are marked with dots by the authors.

Figure 2

Antibiotic resistance in H. pylori from consecutive Bulgarian patients in the first period (2007–2014 for amoxicillin, and 2010–2015 for the other antibiotics) and the second period (2015–2021 for amoxicillin, and 2016–2022 for the other antibiotics) [11,12] (Boyanova, this study).