Prevalence of Antibiotic-Resistant Helicobacter pylori and The Effect on Standard Treatment Prevalence of Antibiotic-Resistant Helicobacter pylori and The Effect on Standard Treatment

Helicobacter pylori infection is one of the most common infections in human worldwide. Chronic infection of H. pylori leads to multiple alimentary diseases including gastric inflammation, atrophic gastritis, peptic ulcer, gastric cancer and gastric mucosa-associated lymphoid-tissue (MALT) lymphoma. Prevalence of H. pylori infection rate has geographic variation which there is a higher prevalence in developing countries including Thailand. It has been found that the infection prevalence is declining. However, the eradication rate of recommended standard treatment is decreasing as well. American College of Gastroenterology on the management of H. pylori infection in 2007 recommends a triple therapy regimen, which consists of a proton pump inhibitor (PPI) and two combined antibiotics (clarithromycin, amoxicillin or metronidazole) as a first-line treatment. Likewise, the Second Asia-Pacific Consensus guideline for H. pylori infection recommends the same regimen. Emerging of H. pyloriantibiotic-resistant strains may affect the efficacy of this standard regimen. Systemic review conducted by Mégraud in 2004 showed that the H. pylori resistance to clarithromycin or metronidazole significantly decreased the eradication rate of standard PPI-based triple therapy. Since the rate of H. pylori resistance is varying on geographic region, choosing the appropriate antibiotic depends on the local resistance rate in each area.