Policy and Market Prospects for Nonantibiotic Therapy

Amid the escalating global crisis of antimicrobial resistance (AMR), the World Health Organization (WHO) designated Helicobacter pylori a priority pathogen for antibiotic resistance in 2017. This designation stems from its high resistance rates to commonly used antibiotics such as clarithromycin, metronidazole, and levofloxacin. Meta-analyses revealed that primary and secondary resistance rates to these antibiotics have surpassed the clinical alert threshold of 15% in most WHO regions. In areas such as the Eastern Mediterranean and Western Pacific, clarithromycin resistance rates even exceed 30% [1]. This situation not only drastically diminishes the efficacy of standard clarithromycin-containing triple therapies—increasing the risk of treatment failure nearly sevenfold in resistant patients—but also highlights the urgent need to establish localized resistance surveillance networks and implement susceptibility-guided individualized treatment strategies worldwide. Concurrently, international consensus increasingly emphasizes avoiding nonselective empirical therapy in high-resistance regions and actively exploring nonantibiotic adjuvant therapies and novel treatment combinations to enhance the management of H. pylori infection and reduce its associated disease burden.