Helicobacter pylori eradication in the face of escalating anti-microbial resistance: Geographic heterogeneity and emerging treatment strategies

Helicobacter pylori (H. pylori) infection is a global health problem that affects more than half of the world population and leads to gastrointestinal disorders such as gastric ulcer, duodenal ulcer and gastric cancer. The available treatment options are inefficient because of patient non-adherence to the regimen due to the polypharmacy approach of treating H. pylori over longer periods. The bio-availability of antibiotics at the gastric mucosa, where the organism resides, is also a major concern. The continuous adaptation of bacteria such as genetic mutation toward beta-lactamase, macrolide and nitroimidazole group of antibiotics and structural barriers such as biofilm or efflux pumps contributes to the decreased efficacy of the antibiotics. These challenges ultimately result in antibiotic resistance. This review discusses the regional disparity in H. pylori infection management and the trend in anti-microbial resistance worldwide. To address these challenges, novel treatment approaches are being explored, ranging from clinically and pre-clinically supported strategies to those still at a conceptual stage, among which gastro-retentive drug delivery, nano-formulation and non-antibiotic therapies are gaining attention worldwide. In conclusion, we suggest effective region-specific management of H. pylori infection with evidence-based emerging treatment strategies to improve eradication outcomes and mitigate anti-microbial resistance.