{
  "abstract": "Background Helicobacter pylori resistance to antibiotics commonly used in eradication regimens is increasing dramatically in many locations; new strategies are needed to manage this infectious disease.Objective This study’s aim was to collect and update information on antibiotic resistance (AR) rates in H. pylori as well as current strategies for H. pylori management, including public health issues, from a global perspective.Design An international survey was conducted in 31 countries on 6 continents to address key issues concerning the management of H. pylori-related AR. Individual aspects included the prevalence of AR for specific antibiotics, antibiotic susceptibility testing (AST) in different healthcare systems, availability of drugs, reimbursement issues and strategies for H. pylori AR surveillance.Results Resistance to the most effective antibiotics used in H. pylori eradication regimens is increasing globally, with clarithromycin and levofloxacin resistance exceeding 15% in 24/31 and 18/31 countries, respectively. Amoxicillin remains an exception, with resistance rates under 2% in 14/31 countries; though African countries have reported amoxicillin resistance rates of over 90%. Bismuth-based treatment regimens are the most effective and are recommended as first-line treatment in several countries. However, more than 1 billion inhabitants worldwide have no access to bismuth-based regimens. PCR-based tests for AR are used in 16/26 countries but are reimbursed in only 4, while next generation sequencing-based tests are available, but not reimbursed, in 3 countries. In 22/26 countries only culture-based methods are available (reimbursed in 9/26 countries). AR surveillance programmes have only been established in 4/26 countries. Therefore, in most countries, empirical therapy with the most effective local regimen available locally is practiced.Conclusion The dramatic global rise in H. pylori antibiotic resistance requires an urgent revision of current management strategies. Possible solutions include AST-based selection of effective treatment regimens, identification of novel combinations of existing drugs and exploration of novel drugs.",
  "authors": [
    {
      "affiliations": [
        "Medical Department 2, LMU Munich, Munich, Germany",
        "German Center for Infection Research (DZIF), partner site Munich, Munich, Germany"
      ],
      "name": "Christian Schulz"
    },
    {
      "affiliations": [
        "Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan"
      ],
      "name": "Jyh-Ming Liou"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Al-Azhar University, Cairo, Egypt"
      ],
      "name": "Mohamed Alboraie"
    },
    {
      "affiliations": [
        "Translational Immune Discovery Unit, Medical Research Council Weatherall Institute of Molecular Medicine (MRC WIMM), Radcliffe Department of Medicine, Oxford University, Oxford, England, UK",
        "Translational Gastroenterology and Liver Unit, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford University, Oxford, England, UK"
      ],
      "name": "Jan Bornschein"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Digestive Endoscopy, Hospital Clínica Bíblica, San José, Costa Rica"
      ],
      "name": "Christian Campos Nunez"
    },
    {
      "affiliations": [
        "Instituto Alfa de Gastroenterologia, Belo Horizonte - MG, Belo Horizonte - MG, Brazil"
      ],
      "name": "Luiz Gonzaga Coelho"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam"
      ],
      "name": "Duc Trong Quach"
    },
    {
      "affiliations": [
        "Division of Gastroenterology, McGill University Heath Center, McGill University Faculty of Medicine, Montreal, Quebec, Canada"
      ],
      "name": "Carlo A Fallone"
    },
    {
      "affiliations": [
        "Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taipei City, Taiwan"
      ],
      "name": "Yi-Chu Chen"
    },
    {
      "affiliations": [
        "German Center for Infection Research (DZIF), partner site Munich, Munich, Germany",
        "Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Technische Universität München, Munich, Germany"
      ],
      "name": "Markus Gerhard"
    },
    {
      "affiliations": [
        "Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain",
        "Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain"
      ],
      "name": "Javier P Gisbert"
    },
    {
      "affiliations": [
        "Gastroenterology, University of Ulsan College of Medicine, Songpa-gu, Korea (the Republic of)"
      ],
      "name": "Hwoon-Yong Jung"
    },
    {
      "affiliations": [
        "Gastroenterology Department, Concord Hospital, Sydney, New South Wales, Australia"
      ],
      "name": "Peter H Katelaris"
    },
    {
      "affiliations": [
        "Division of Gastroenterology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea (the Republic of)"
      ],
      "name": "Jae Gyu Kim"
    },
    {
      "affiliations": [
        "GI Division, Shanghai Jiao-Tong University School of Medicine Renji Hospital Shanghai Institution of Digestive Disease, Shanghai, China"
      ],
      "name": "Hong Lu"
    },
    {
      "affiliations": [
        "German Center for Infection Research (DZIF), partner site Munich, Munich, Germany",
        "Medical Department 2, Ludwig Maximilian University of Munich, Munich, BY, Germany"
      ],
      "name": "Lukas Macke"
    },
    {
      "affiliations": [
        "Center of Excellence in Digestive Diseases, Department of Medicine, Thammasat University, Bangkok, Bangkok, Thailand"
      ],
      "name": "Varocha Mahachai"
    },
    {
      "affiliations": [
        "Medicine, Rhode Island Hospital/Brown University, Providence, Rhode Island, USA"
      ],
      "name": "Steven F Moss"
    },
    {
      "affiliations": [
        "Digestive Physiology and Motility Lab, Medical Biological Research Institute, Universidad Veracruzana, Veracruz, Veracruz, Mexico"
      ],
      "name": "Jose Maria Remes Troche"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Pontificia Universidad Catolica de Chile, Santiago, Región Metropolitana, Chile",
        "Center for Prevention and Control of Cancer (CECAN), Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile"
      ],
      "name": "Arnoldo Riquelme"
    },
    {
      "affiliations": [
        "Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy"
      ],
      "name": "Marco Romano"
    },
    {
      "affiliations": [
        "University of Cape Town, Rondebosch, South Africa"
      ],
      "name": "Mashiko Setshedi"
    },
    {
      "affiliations": [
        "Nigerian Institute of Medical Research, Lagos, Nigeria"
      ],
      "name": "Stella Smith"
    },
    {
      "affiliations": [
        "German Center for Infection Research (DZIF), partner site Munich, Munich, Germany",
        "Chair of Medical Microbiology and Hospital Epidemiology, Max von Pettenkofer Institute, Faculty of Medicine, LMU Munich, Munich, Germany"
      ],
      "name": "Sebastian Suerbaum"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Faculty of Medicine, University of Mbujimayi, Mbujimayi, Congo (the Democratic Republic of the)",
        "Research Center for Infectious Disease Sciences, Osaka Metropolitan University, Osaka, Osaka Prefecture, Japan"
      ],
      "name": "Evariste Tshibangu-Kabamba"
    },
    {
      "affiliations": [
        "Thammasat University, Bangkok, Bangkok, Thailand"
      ],
      "name": "Ratha-Korn Vilaichone"
    },
    {
      "affiliations": [
        "Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Tehran Province, Iran (the Islamic Republic of)"
      ],
      "name": "Abbas Yadegar"
    },
    {
      "affiliations": [
        "Department of Environmental and Preventive Medicine, Oita University Faculty Of Medicine, Yufu, Oita Prefecture, Japan",
        "Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas, USA"
      ],
      "name": "Yoshio Yamaoka"
    },
    {
      "affiliations": [
        "INSERM U1312 BRIC, University of Bordeaux, Talence, Nouvelle-Aquitaine, France"
      ],
      "name": "Francis Mégraud"
    },
    {
      "affiliations": [
        "UNSW Microbiome Research Centre, University of New South Wales, Sydney, New South Wales, Australia"
      ],
      "name": "Emad M El-Omar"
    },
    {
      "affiliations": [
        "Department of Medicine, Jichi Medical School, Tochigi, Japan"
      ],
      "name": "Kentaro Sugano"
    },
    {
      "affiliations": [
        "Medical Department 2, LMU Munich, Munich, Germany"
      ],
      "name": "Peter Malfertheiner"
    }
  ],
  "title": "Helicobacter pylori antibiotic resistance: a global challenge in search of solutions",
  "uid": "4706d18e-2274-50c5-a42f-f66d444273bc"
}