Global Escalation of H pylori Antibiotic Resistance Spurs Call for Action

A comprehensive international survey has revealed a significant global rise in antibiotic resistance (AR) among Helicobacter pylori (H. pylori) strains, highlighting the urgent need for revised treatment strategies and enhanced surveillance systems, authors reported in Gut.

Researchers from 31 countries across 6 continents assessed AR prevalence, testing practices, and access to therapies to inform a global management approach.

Resistance to commonly used antibiotics, particularly clarithromycin and levofloxacin, exceeded 15% in 24 and 18 countries, respectively. In contrast, amoxicillin resistance remained low (<2%) in many regions, except in some African countries, where rates exceed 90%. Bismuth-based quadruple therapy emerged as a preferred first-line option; however, it remains inaccessible to more than 1 billion people globally.

Diagnostic tools also face major accessibility and reimbursement hurdles, the investigators explained. Culture-based antibiotic susceptibility testing (AST) is the most common method but is reimbursed in only 9 of 26 reporting countries. PCR-based testing is available in 16 nations but covered in only 4. Next-generation sequencing is underused and not reimbursed in any of the 3 countries reporting its availability. Furthermore, only 4 countries have established nationwide AR surveillance programs.

The authors stressed, “The dramatic global rise in H. pylori antibiotic resistance requires an urgent revision of current management strategies.” They added that future directions must prioritize “AST-based selection of effective treatment regimens, identification of novel combinations of existing drugs and exploration of novel drugs.”

Reference

Schulz C, Liou J-M, Alboraie M, et al. Helicobacter pylori antibiotic resistance: a global challenge in search of solutions. Gut. Published Online First: 11 July 2025. doi: 10.1136/gutjnl-2025-335523