H. pylori treatment in a resistant world: Regional strategies for effective eradication: A narrative review

The transmission of Helicobacter pylori (H. pylori) is still a major global health concern. As antibiotic resistance increases, the efficacy of traditional treatment plans—which are mostly dependent on proton pump inhibitors and antibiotics—is being gradually undermined. This review examines the regional variations in H. pylori treatment guidelines, shaped by local resistance patterns, healthcare infrastructure, and available therapies. In regions with high resistance, such as South Asia, bismuth quadruple therapy has become the preferred first-line option, offering higher eradication rates. In contrast, countries like Japan and South Korea have seen improved outcomes with the introduction of potassium-competitive acid blockers (P-CABs) and high dose amoxicillin-based regimens respectively. These regional disparities highlight the significance of tailoring H. pylori treatment to local resistance trends in order to tackle the growing threat of antibiotic resistance. The purpose of this review is to investigate geographical variations in Helicobacter pylori antibiotic resistance patterns and their impact on treatment methods. By highlighting how resistance trends impact therapeutic outcomes, this review seeks to guide clinicians in selecting the most effective, region-specific therapies for H. pylori eradication. Additionally, it underscores the critical need for ongoing research to better understand resistance dynamics and inform updated treatment guidelines, ensuring improved patient outcomes and combating the global rise of antimicrobial resistance.