Global Primary Antibiotic Resistance Rate of Helicobacter pylori in Recent 10 years: A Systematic Review and Meta-Analysis

Epidemiological characteristics of Helicobacter pylori infection and antibiotic resistance in urban areas of Guangdong Province, China: a multi-center, cross-sectional surveillance

PURPOSE

Helicobacter pylori (H. pylori) infection is widespread globally and can cause serious gastrointestinal complications, including gastric cancer. This study assesses the prevalence and antibiotic resistance of H. pylori in Guangdong, one of China's most developed provinces.

METHODS

A multi-center, cross-sectional study was conducted across six cities in Guangdong provinces, that is, Guangzhou, Shenzhen, Heyuan, Foshan, Yunfu, and Zhaoqing. Non-invasive gastric fluid samples were collected via the string test, and H. pylori infection and antibiotic resistance were detected using quantitative PCR. Risk factors for infection were analyzed.

RESULTS

Of 1,764 participants, 444 (25.17%) tested positive for H. pylori, with the highest infection rate in Foshan (29.81%). Antibiotic resistance testing of these 444 infected individuals revealed that, except for levofloxacin resistance in Yunfu (14.29%), clarithromycin resistance in Yunfu and resistance to other antibiotics in all cities exceeded the 15% threshold. Infection rates were significantly higher in males (OR 1.29, 95% CI 1.03-1.60, p = 0.03) and obese individuals (OR 2.04, 95% CI 1.04-3.91, p = 0.03), with obesity identified as an independent risk factor.

CONCLUSION

This study provides a comprehensive update on the prevalence, antibiotic resistance, and risk factors of H. pylori infection in Guangdong, offering valuable insights for public health strategies aimed at improving diagnosis and treatment.

Helicobacter pylori and gastric disease

The infection caused by Helicobacter pylori is the most common on the planet, affecting half of the global population. It is usually transmitted during childhood and persists for life if untreated. It is the primary cause of chronic gastritis, peptic ulcer, and gastric cancer. In young dyspeptic patients without alarm symptoms, the test-and-treat strategy (detection of H. pylori through a non-invasive test and subsequent eradication) is the preferred approach. The causal role of the infection in the development of gastric adenocarcinoma provides an opportunity to implement preventive strategies. The infection can be diagnosed through invasive methods (requiring endoscopy, such as the rapid urease test or histology) and non-invasive methods (such as the breath test or stool antigen test). The treatment for H. pylori combines a proton pump inhibitor with several antibiotics or bismuth salts.

Helicobacter pylori Antibiotic Resistance in Russia: A Systematic Review and Meta-Analysis

Objective: This systematic review and meta-analysis aims to evaluate the temporal changes in Helicobacter pylori antibiotic resistance in Russia based on studies published over the past 15 years. Materials and Methods: We conducted a comprehensive literature search in MEDLINE/PubMed, EMBASE, the Russian Science Citation Index, and Google Scholar, following the PRISMA 2020 guidelines. Our meta-analysis was pre-registered in PROSPERO (CRD 420251025636). The inclusion criteria included original research, published in English or Russian in 2011-2024, involving antibiotic susceptibility testing in treatment-naive Russian adults using validated diagnostic methods. Two independent researchers selected studies and extracted data using standardized procedures, with methodological quality assessed via the Newcastle-Ottawa Scale. Pooled resistance rates were calculated using fixed/random-effects models in MedCalc 23.1.5 and Python 3.9.21, with meta-regression investigating temporal trends and subgroup analyses examining regional and methodological variations. Results: We identified 16 studies comprising 1206 H. pylori isolates. The pooled analysis of studies (2011-2025) revealed an overall clarithromycin resistance rate of 15.236%, with a significant temporal increase from 11.903% pre-2015 to 21.024% in 2020-2024 (p = 0.0049). Metronidazole showed consistently high pooled resistance (33.309%), while amoxicillin (1.828%), levofloxacin (19.014%), tetracycline (1.328%), and rifampicin (5.803%) maintained low resistance rates, and dual clarithromycin-metronidazole resistance was observed in 2.793% of isolates. Regional disparities were notable in the two largest cities of Russia, with 18.763% clarithromycin resistance in Moscow versus 28.540% in Saint-Petersburg. Conclusions: Russia surpasses the Maastricht VI Consensus resistance threshold for clarithromycin (15%), necessitating revision of empirical treatment strategies. The significant increase in clarithromycin resistance, potentially exacerbated by antibiotic use during the COVID-19 pandemic, underscores the urgent need for resistance-guided therapies and ongoing national surveillance programs to optimize H. pylori management.

Comparison of Efficacy on First-Line Helicobacter Pylori Eradication Between Potassium-Competitive Acid Blocker (P-CAB)-Based Therapies Versus Proton-Pump Inhibitor (PPI)-Based Therapies: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Helicobacter pylori (H. pylori) is a gram-negative bacterium that infects over half of the world population, accountable for 89% of all gastric cancer cases. The efficacy of the proton-pump inhibitor (PPI) based-triple therapy is declining, while the novel potassium-competitive acid blocker (P-CAB) based therapy gets new attention. However, it remains unclear regarding the optimal duration and number of comedication(s) for P-CAB-based regimens, which P-CAB is the best-in-class, and whether P-CABs perform better than all PPIs.

OBJECTIVE

To compare the efficacy on first-line H. pylori eradication between P-CAB-based therapies versus PPI-based therapies.

METHODS

A systematic review on randomized controlled trials, with network meta-analysis conducted under the Frequentist approach. The P-score method was used to rank the probability of being the best intervention.

RESULTS

For the first-line treatment eradicating H. pylori infection, the 7-day vonoprazan-based triple therapy (VAC7) has the highest P-score for the probability of being the best intervention (0.96). VAC7 has a significantly higher eradication rate of H. pylori than most PPI-based therapies, including esomeprazole-based, lansoprazole-based, pantoprazole-based, and omeprazole-based regimens, as well as the other P-CAB based regimens, such as tegroprazan-based triple regimen (OR: 2.41, 95% CI: 1.13-5.15).

CONCLUSION

Vonoprazan-based triple therapy has a higher eradication rate than PPI-based triple therapies, as well as other P-CABs based regimens. It remains unclear whether VAC7 is superior over vonoprazan-based dual therapy (VA7). Overall, VAC7 should be recommended for clinical and public health interventions, with VA7 as a possible alternative considering the local antimicrobial resistance profiles.

Overcoming antibiotic-resistant Helicobacter pylori infection: Current challenges and emerging approaches

Recent studies have shown a noticeable increase in global Helicobacter pylori (H. pylori) resistance, with clarithromycin resistance surpassing 15% in various areas. However, inadequate epidemiological monitoring, especially in developing countries, and the absence of uniform testing methods lead to discrepancies between regions and a possible underestimation of resistance levels. The complexity of treating H. pylori is driven by its highly dynamic genome, which is prone to frequent mutations contributing to phenotypical resistance. The usual course of action in empirical treatment involves using a combination of various drugs simultaneously, leading to significant resistance selection pressure and potential side effects. The emergence of H. pylori strains resistant to multiple drugs is closely tied to failures in first-line treatment, highlighting the need to prevent further resistance by using optimal initial empirical therapy or regimens guided by antibiotic susceptibility testing, requiring a collection of mixed samples and multiple isolates for accurate assessment. The emergence of new treatments like potassium-competitive acid blockers offers a hopeful approach to decrease antimicrobial usage while still ensuring effectiveness in comparison to traditional therapies with proton pump inhibitors. Additionally, the use of probiotics is under investigation to identify specific strains and formulations that may mitigate therapy-associated adverse effects.

Efficacy and Safety of Modified Bismuth Quadruple Therapy for First-Line Helicobacter pylori Eradication: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

This study aimed to evaluate the efficacy of adding bismuth to conventional triple therapy (modified bismuth quadruple therapy [mBQT]) for Helicobacter pylori treatment-naïve patients in an era of increasing eradication failure. We performed a comprehensive literature search up to December 2024 using PubMed, Embase, and the Cochrane Library to investigate mBQT's benefits. The comparative treatments were as follows: (1) triple therapy without bismuth (TT), (2) non-BQTs (sequential and concomitant), and (3) classic BQT (cBQT) containing metronidazole and tetracycline. Randomized controlled trials (RCTs) were analyzed to compare eradication rates, adverse drug events, and patient compliance between the mBQT and comparison groups. In total, 9162 and 8449 patients from 43 trials in 35 RCTs were included in the intention-to-treat and per-protocol analyses, respectively. The mBQT group had a superior pooled eradication rate compared to the TT group (84.8% vs. 74.1%, p < 0.00001, and odds ratio [OR] = 2.02 [1.61-2.55]). The mBQT showed a similar eradication rate to the non-BQT and cBQT groups (80.8% vs. 80.2%, p = 0.55, and OR = 1.09 [0.83-1.43] in the non-BQT group; 81.5% vs. 83.0%, p = 0.36, and OR = 0.84 [0.59-1.21] in the cBQT group). Regarding adverse drug events, there was no significant difference between the mBQT and comparison groups (25.4% vs. 27.5%, p = 0.53, and OR = 0.95 [0.80-1.12]). The subgroup analysis showed that patient adherence to mBQT was significantly higher than to cBQT (96.4% vs. 93.3%, p = 0.004, and OR = 1.83 [1.21-2.77]). Our meta-analysis showed that mBQT was an effective and tolerable first-line therapy for H. pylori eradication.

Do policies that allow access to unregistered antimicrobials address the unmet need? Australia as a case study of a high-income country with universal healthcare

Background

Ensuring timely and equitable access to effective and optimal antimicrobials is crucial for optimal patient care, to minimize the use of less appropriate treatment options and reduce the risk of antimicrobial resistance (AMR).

Objectives

To determine the average time for new antibacterials to gain registration for use in Australia after obtaining marketing approval internationally, and to quantify the use of 'new' and older unregistered antimicrobials in Australian clinical practice between 2018 and 2023.

Methods

Two data sources were utilized to estimate the usage of antimicrobials not registered for use in Australia. Annual hospital inpatient usage data were sourced from the National Antimicrobial Utilisation Surveillance Program (NAUSP) and data on Special Access Scheme (SAS) applications for unregistered antimicrobial was sourced from the Australian Government Department of Health and Aged Care.

Results

Between 2018 and 2023 there were 36 131 applications to access unapproved antimicrobials in Australia. In 26.6% of cases, access to an unapproved antimicrobial was for the treatment of a critically ill patient. Levofloxacin, pyrazinamide, tetracycline and pristinamycin were the most frequently accessed unregistered antimicrobials. Applications for 'new' antibacterials increased from 55 in 2018 to 249 in 2023. Inpatient use of nine new antibacterials was reported in Australian hospitals in 2023, two registered and seven unregistered.

Conclusions

Unapproved antimicrobials are frequently accessed by clinicians for patients unable to be treated with registered antimicrobials in Australia. Policy reform and economic incentives are required to support the registration of antimicrobials needed for otherwise untreatable infections and to ensure the sustainability of supply.

Helicobacter pylori in Bahrain: A Comprehensive Study of Patient Characteristics, Treatment Approaches, and Cure Rates

Introduction Helicobacter pylori (H. pylori) bacteria is a major cause of gastritis, peptic ulcer disease, and functional dyspepsia. Although the treatment of H. pylori has evolved over time, challenges exist due to antibiotic resistance and variations in treatment outcomes. This study aimed to determine the characteristics and treatment outcomes of patients with H. pylori infection in Bahrain. Materials and methods A cross-sectional study of adults with H. pylori attending primary and secondary care settings was conducted. H. pylori was diagnosed based on the urea breath test. A computer-based simple random sample was obtained. Patients and treatment characteristics were determined from medical records. Descriptive and inferential analyses were conducted. Results A total of 709 patients were included, with an average age of 40.9±14.9 years. Nearly two-thirds of the participants were females (n=461, 65%) and diagnosed in primary care settings (n=464, 65.4%). Of the participants, 74.9% received treatment for H. pylori, with triple therapy (n=384, 72.3%) being the most used regimen in primary and secondary care hospitals, followed by the concomitant regimen (n=72, 13.6%). Bismuth-based quadruple therapy (P<0.001), concomitant therapy (P<0.001), and levofloxacin triple therapy (P=0.020) were used more frequently in secondary care settings compared to primary care settings. Nearly one-third of the patients underwent a test of cure (n=260, 36.7%). No significant association was found between the used regimen and the cure rate (P=0.938). Conclusion In summary, this study revealed comparable cure rates for H. pylori regardless of the antimicrobial regimens. Although most participants who underwent the test of cure had a negative test, the study highlighted the suboptimal management and follow-up of H. pylori cases. Prospective randomized controlled trials are needed to determine the exact effectiveness of each regimen among patients with H. pylori.

Effect of an individualized bismuth quadruple regimen guided by 10-day or 14-day antibiotic susceptibility testing for first-line eradication treatment of Helicobacter pylori in Ningxia, China

Introduction

Helicobacter pylori (H. pylori) is becoming more resistant to antibiotics, and the implementation of individualized therapy is highly valuable for its eradication. This study aimed to investigate the efficacy and safety of individualized treatment guided by antibiotic susceptibility testing (AST) with a 10-day or 14-day course for the eradication of H. pylori.

Methods

This was a prospective, open-label, single-center, quasi-randomized trial in which 220 participants were randomized into groups based on AST results as AST-10-day (n = 98) and AST-14-day (n = 112) treatment groups. All participants were retested for a 14-carbon urease breath test at weeks 4-8 after the end of the treatment.

Results

The primary resistance rates of H. pylori to metronidazole, levofloxacin, clarithromycin, and amoxicillin were 94.1% (207/220), 42.7% (95/220), 41.4% (91/220), and 0.9% (2/220), respectively; however, no resistance to furazolidone and tetracycline was observed. In the AST-10-day and AST-14-day groups, the intention-to-treat (ITT) eradication rates were 89.8% (88/98) and 90.2% (110/122), respectively, with no statistically significant difference (p = 0.928). The per-protocol (PP) eradication rates were 92.6% (88/95) and 98.2% (110/112), respectively, with a statistically significant difference (p = 0.049). The incidence rates of adverse events (AEs) in the AST-10-day and AST-14-day groups were 6.3% (6/95) and 7.2% (8/112), respectively, with no statistically significant difference (p = 0.813). No statistically significant difference was observed in compliance between the two groups (p = 0.467).

Conclusion

Both 10-day and 14-day AST guided individualized therapy can achieve satisfactory eradication effect. Compared with the 14-day regimen, the 10-day regimen has similar eradication rate and incidence of adverse events and compliance but shorter duration and lower cost.

Managing Helicobacter pylori as an Infectious Disease: Implementation of Antimicrobial Stewardship

Helicobacter pylori is prevalent globally and implicated in various gastric diseases and malignancies. Rising antibiotic resistance has increasingly compromised the effectiveness of standard H. pylori eradication therapies. This review explores the role of antimicrobial stewardship (AMS) as a structured approach to optimizing H. pylori management through the "5D" strategy: Diagnosis-utilizing advanced diagnostic tools to accurately detect bacterial resistance; Drug-selecting antibiotics tailored to resistance profiles and patient-specific factors; Dosage-optimizing dosing and frequency based on pharmacokinetic properties to maximize efficacy; Duration-employing shorter treatment courses where supported by evidence; and Discontinuation-balancing the benefits and risks of repeated antibiotic treatments. We discuss recent advances in diagnostic technologies, such as polymerase chain reaction and next-generation sequencing, and their impact on therapeutic decision-making. Additionally, we evaluate treatment regimens, with a particular focus on emerging alternatives such as regimens containing potassium-competitive acid blockers. Given the growing global resistance and limited pipeline for new antibiotics, we advocate for a more strategic and resource-conscious approach to H. pylori management, integrating AMS principles within the "One Health" framework to address the pathogen's transmission across humans, animals, and the environment. With advancements in resistance testing and diagnostics, H. pylori therapies are likely to become increasingly personalized and precise. To achieve this, effective AMS implementation necessitates interdisciplinary collaboration to maximize therapeutic outcomes, minimize adverse effects, combat resistance, and reduce healthcare costs.

Helicobacter pylori Antimicrobial Susceptibility Testing-Guided Eradication Therapy in the Southeast Region of China: A Retrospective Study

Background and Aim

Antibiotic resistance of Helicobacter pylori is increasing worldwide, lowering its efficacy in eradication therapy and posing a serious threat to human health. This study evaluated H. pylori resistance to antibiotics in the southeast region of China and explored factors related to eradication failure guided by antimicrobial susceptibility testing (AST).

Methods

In this retrospective study, patients who tested positive underwent gastroscopy, and H. pylori infection was confirmed by histological staining and H. pylori culture. We determined the rate of H. pylori antibiotic resistance, success rate of AST-guided eradication therapy, and risk factors associated with treatment failure.

Results

Among the 210 enrolled patients, 188 (89.5%) had successful cultures, and 183 (87.1%) underwent AST. The most common antibiotic resistance was to metronidazole and clarithromycin (89.6%), followed by levofloxacin (68.3%), and amoxicillin (14.2%). Furazolidone (3.0%) and tetracycline (0.5%) showed relatively low resistance rates. There were no statistically significant differences in the rates of resistance to MET, LEV, or AMX between naive and non-naive patients. However, CLA resistance rates in non-naive patients were significantly higher than those in naive patients. The overall success rate of AST-guided therapy was high and showed no significant difference between first-line and rescue therapy. Sex, age, prior therapy, and proton pump inhibitors (PPIs) or potassium-competitive acid blockers (P-CABs) use were not significantly associated with an increased risk of eradication failure in AST-guided therapy.

Helicobacter pylori Efflux Pumps: A Double-Edged Sword in Antibiotic Resistance and Biofilm Formation

Helicobacter pylori is a major pathogen associated with various gastric diseases. Despite decades of research, the treatment of H. pylori remains challenging. One of the primary mechanisms contributing to failures of therapies targeting this bacterium is genetic mutations in drug target sites, although the growing body of scientific data highlights that efflux pumps may also take part in this process. Efflux pumps are proteinaceous transporters actively expelling antimicrobial agents from the interior of the targeted cells and reducing the intracellular concentration of these compounds. Considering that efflux pumps contribute to both antimicrobial resistance and biofilm formation, an in-depth understanding of their properties may constitute a cornerstone in the development of novel therapeutics against H. pylori. In line with this, the aim of the current review is to describe the multitude of efflux pumps produced by H. pylori and present the data describing the involvement of these proteins in tolerance and/or resistance to various classes of antimicrobial substances.

Effects of Lactobacillus spp. on Helicobacter pylori: A Promising Frontier in the Era of Antibiotic Resistance

Helicobacter pylori, a pathogenic bacterium responsible for multiple gastrointestinal disorders, has emerged as a major global concern due to rise in antibiotic resistance. Unwanted side effects of antibiotics therapy are further complicating the treatment strategies. Consequently, an alternative approach, using probiotics has emerged as a promising solution for treating H. pylori infections. Probiotics have shown considerable potential in increasing the cure rate and reducing the side effects through diverse mechanisms. Among the widely employed probiotics, Lactobacillus spp. has garnered particular attention in this review. After reviewing the studies on effects of Lactobacillus spp. on H. pylori, it is evident that several Lactobacillus spp. have demonstrated their potential efficacy against H. pylori infection, when administered alone or in conjunction with antibiotics, in a strain-specific manner. Furthermore, the inclusion of Lactobacillus spp. in the treatment regimen has also been associated with a reduction in the side effects related to antibiotic-based therapies. Future research may focus on identifying optimal strains and treatment regimens, understanding the long-term impacts of use, and determining their role in preventing H. pylori infection in various populations.

Overcoming the effects of increasing antimicrobial resistance on Helicobacter pylori therapy

INTRODUCTION

Resistance to the antibiotics used to treat Helicobacter pylori (H. pylori) has risen to alarming levels worldwide emphasizing the need to reconsider the approach to therapy generally and to reconsider whether to continue use of many previously highly effective treatment regimens.

AREAS COVERED

This review covers current aspects management of the response to the effects of antimicrobial resistance on H. pylori therapy.

EXPERT OPINION

The prevalence of antimicrobial resistance to H. pylori is increasing and must now be integrated into management of the infection. Bacterial factors responsible for resistance include mutations, efflux pumps, and biofilm formation. Societal factors include overuse and misuse of antibiotics, including in the therapy of H. pylori infections. H. pylori infections should be managed as an infectious disease based on the principles of antimicrobial stewardship which should be incorporated into ongoing community-based and hospital programs of antibiotic stewardship to provide up-to-date advice regarding susceptibility and locally optimized best treatment practices (i.e. advice on which drugs, doses, formulation, frequency of administration, etc. The infection would best be managed in concert with infectious disease especially in asymptomatic patients. Gastroenterology's input remains critical for management of complications of the infection such as peptic ulcer disease.

Tegoprazan-Amoxicillin Dual Therapy for Helicobacter pylori Eradication: A Prospective, Randomized, Multicenter Study in Fujian, China

INTRODUCTION

Few studies have investigated the efficacy and safety of tegoprazan-amoxicillin (TA) dual therapy for Helicobacter pylori eradication. We aim to evaluate the effectiveness and safety of different dosages of TA dual therapy for H. pylori eradication.

METHODS

This prospective, randomized, open-label, multicenter study was conducted at four centers in Fujian, China. H. pylori-infective patients were randomized 1:1:1 to receive one of the following treatments: bismuth quadruple therapy (BQT, esomeprazole 20 mg twice daily + potassium bismuth citrate 240 mg twice daily + amoxicillin 1 g twice daily + clarithromycin 500 mg twice daily), tegoprazan-amoxicillin dual therapies (TA-qd, tegoprazan 50 mg once daily + amoxicillin 1 g thrice daily; TA-bid, tegoprazan 50 mg twice daily + amoxicillin 1 g thrice daily) for 14 days. The primary outcome was noninferiority in eradication rates of the different TA groups compared to the BQT group. Secondary outcomes encompassed an assessment of adverse reactions and clinical symptom relief. Additionally, exploratory outcomes were focused on the shifts in gut microbiota and a cost-effectiveness analysis.

RESULTS

A total of 321 patients were enrolled. The eradication rates in the BQT group, TA-qd group, and TA-bid group were 85.05% (91/107), 85.98% (92/107), and 85.98% (92/107) in the intention-to-treat analysis (ITT) (BQT vs. TA-qd, 95% CI -8.50% to 10.36%, noninferiority p = 0.012; BQT vs. TA-bid, 95% CI -8.50% to 10.36%, noninferiority p = 0.012); 91.00% (91/100), 91.09% (92/101), and 92.93% (92/99) in the modified intention-to-treat analysis (mITT) (BQT vs. TA-qd, 95% CI -7.81% to 7.98%, noninferiority p = 0.006; BQT vs. TA-bid, 95% CI -5.62% to 9.48%, noninferiority p < 0.001); 90.81% (89/98), 91.00% (91/100), and 93.81% (91/97) in the per-protocol analysis (PP) (BQT vs. TA-qd, 95% CI -7.83% to 8.19%, noninferiority p = 0.006; BQT vs. TA-bid, 95% CI 4.46% to 10.46%, noninferiority p < 0.001). The incidence of adverse reactions in the TA-qd and TA-bid groups was significantly lower than in the BQT group (13.33%, 14.56%, and 27.18%, respectively; p = 0.017). The complete remissions of clinical symptoms for BQT, TA-qd, and TA-bid were 36.89%, 65.71%, and 68.93%, respectively, had significant differences (p < 0.001). Two weeks of TA therapy altered gut microbiota diversity and composition, but that recovered 4 weeks after discontinuation. The cost-effectiveness ratios (CERs) for BQT, TA-qd, and TA-bid were 1.85 CNY, 2.08 CNY, and 3.69 CNY, respectively.

CONCLUSION

Both TA dual therapies provided satisfactory eradication rates of > 90% for eradicating H. pylori, fewer adverse reactions, and greater clinical symptom relief compared to BQT, with a mild, reversible impact on gut microbiota. In addition, the TA dual therapy with low doses of tegoprazan showed better cost-effectiveness.

TRIAL REGISTRATION

Chinese Clinical Trial Register and registration No.: ChiCTR2300071997.

Molecular Mechanisms of Biofilm Formation in Helicobacter pylori

BACKGROUND

Biofilm formation in Helicobacter pylori (H. pylori) helps bacteria survive antibiotic exposure and supports bacterial colonization and persistence in the stomach. Most of the published articles have focused on one aspect of the biofilm. Therefore, we conducted the current study to better understand the mechanism of biofilm formation, how the biofilm contributes to antibiotic resistance, and how the biofilm modifies the medication delivery mechanism.

METHODS

We conducted a literature review analysis of the published articles on the Helicobacter pylori biofilm between 1998 and 2024 from the PubMed database to retrieve eligible articles. After applying the inclusion and exclusion criteria, two hundred and seventy-three articles were eligible for our study.

RESULTS

The results showed that biofilm formation starts as adhesion and progresses through micro-colonies, maturation, and dispersion in a planktonic form. Moreover, specific genes modulate each phase of biofilm formation. Few studies have shown that mechanisms, such as quorum sensing and diffusible signal factors, enhance coordination among bacteria when switching from biofilm to planktonic states. Different protein expressions were also observed between planktonic and biofilm strains, and the biofilm architecture was supported by exopolysaccharides, extracellular DNA, and outer membrane vesicles.

CONCLUSIONS

This infrastructure is responsible for the increased survival of bacteria, especially in harsh environments or in the presence of antibiotics. Therefore, understanding the biofilm formation for H. pylori is crucial. This study illustrates biofilm formation in H. pylori to help improve the treatment of H. pylori infection.

Subinhibitory concentrations of antibiotics affect development and parameters of Helicobacter pylori biofilm

Introduction

Helicobacter pylori causes chronic gastric diseases in nearly 50% of people around the world. It is suggested that biofilm formation has a pronounced effect on the dynamic resistance spread and recurrence of these infections.

Methods

To mimic the scenario of therapeutic ineffectiveness, we investigated the impact of sub-minimal inhibitory concentrations (sub-MICs) of antibiotics on the development and parameters of biofilms produced by clinical H. pylori strains.

Results

We observed that constant exposure of planktonic forms to metronidazole or levofloxacin stimulated the speed of autoaggregation and the amount of extracellular matrix, resulting in increased dimensions of the developed biofilms. Contrary to this, continuous exposure to clarithromycin negatively affected a number of biofilm-related reactions and led to the biofilm-weakening effect. Through assessing the membrane fatty acid profiles of antibiotic-exposed cells, we confirmed that metronidazole and levofloxacin induced a biofilm-like phenotype, while clarithromycin kept bacteria in a planktonic form.

Discussion

Our results suggest that sub-MICs of antibiotics affect the biochemical and biophysical properties of the developing biofilm of H. pylori strains and may impact the effectiveness of antibiotic treatment.

Comparison of Amoxicillin Administered Twice versus Four Times a Day in First-Line Helicobacter pylori Eradication Using Tegoprazan, Clarithromycin, and Bismuth: A Propensity Score Matching Analysis

This study aimed to investigate the effects of different amoxicillin (AMX) dosing schedules on bismuth quadruple therapy in Helicobacter pylori treatment-naïve patients. A total of 139 H. pylori-infected patients received a 2-week eradication regimen consisting of 50 mg tegoprazan, 500 mg clarithromycin, and 300 mg bismuth tripotassium dicitrate twice daily, 1000 mg AMX twice daily (BID group), or 500 mg AMX four times daily (QID group). We performed a urea breath test to evaluate H. pylori eradication eight weeks after treatment and compared the H. pylori eradication rate, patient compliance, and adverse drug events between the BID and QID groups. Based on propensity score matching, 114 and 100 patients were included in intention-to-treat (ITT) and per-protocol (PP) analyses, respectively. The H. pylori eradication rate did not differ significantly according to the ITT (82.5% vs. 87.7%, p = 0.429) and PP (95.9% vs. 98.0%, p = 0.536) analyses between the BID and QID groups. No significant differences were found in treatment compliance or adverse drug event rates between the two groups. In conclusion, the eradication rate of first-line H. pylori therapy containing tegoprazan, clarithromycin, and bismuth was not affected by AMX dosing schedules administered twice and four times daily.