The Crisis of Antimicrobial Resistance in Helicobacter pylori
Helicobacter pylori (H pylori) remains one of the most prevalent bacterial infections worldwide, affecting approximately half of the global population. It is the primary etiological agent for chronic gastritis, peptic ulcer disease, and gastric adenocarcinoma. For decades, the standard of care has relied on empirical triple or quadruple antibiotic therapies. However, the efficacy of these regimens has plummeted due to the rapid emergence of antimicrobial resistance (AMR), particularly against clarithromycin and levofloxacin. The World Health Organization has categorized clarithromycin-resistant H pylori as a high-priority pathogen, emphasizing the urgent need for innovative diagnostic and therapeutic strategies.
Traditional antimicrobial susceptibility testing (AST) for H pylori is notoriously difficult. The bacterium is fastidious, requiring specific growth conditions and long incubation periods, which often leads to low culture success rates in clinical settings. Consequently, clinicians frequently prescribe antibiotics without knowing the resistance profile of the specific strain infecting the patient. This empirical approach not only risks treatment failure but also drives further resistance. A recent landmark study published in Lancet Microbe by Martínez-Martínez and colleagues provides a robust genomic framework to transition from empirical to personalized, genotype-based H pylori management.
