Regional Antibiotic Resistance of Helicobacter pylori

Antibiotic resistance is considered the cause of unsuccessful eradication of Helicobactor pylori (H. pylori) infections. Awareness of regional resistance rates of H. pylori isolates can improve not only empiric antibiotic therapy but also lead to the development of second line treatment and rescue regimens. At present, the most common treatment is empiric eradication. Global regional regimen therapies should be based upon regional in vitro antibiotic resistance rates. This approach is crucial in successfully treating the individual patient. However, in regions where antibiotic susceptibility testing is unavailable, epidemiological data for secondary H. pylori resistance are essential for the judicious use of antibiotics following several treatment failures. Primary H. pylori resistance to clarithromycin is less prevalent worldwide than H. pylori resistance to metronidazole. Secondary resistance that develops in vivo in previously susceptible organisms has been documented in cases of therapeutic failures. All antibiotics used to treat H. pylori are widely used to treat other bacterial infections. Pretreatment exposure of H. pylori to inadequate levels of these drugs as well as the use of inadequate regional antibiotics is associated with secondary resistance. Herein, we review regional resistance rates of H. pylori isolates to clarithromycin, metronidazole and levofloxacin, the main antimicrobial agents used for eradication of H. pylori.