The Future of Nonantibiotic Therapy

Helicobacter pylori infection is a significant global public health challenge. Recent meta-analyses have indicated that in Asia, particularly East Asia, H. pylori infection significantly elevates the risk of cardia gastric cancer, with an odds ratio as high as 2.2, and this trend is increasing. Concurrently, the efficacy of traditional antibiotic triple or quadruple therapy has declined, with eradication success rates falling below 70% because of continuously increasing drug resistance; some resistant strains exhibit resistance rates exceeding 30%. Furthermore, broad-spectrum antibiotic treatment can disrupt the intestinal microbiota balance, inducing dysbiosis, secondary infections, and metabolic disorders, thereby further impacting patient health. The increasing challenge of H. pylori drug resistance necessitates the development of novel nonantibiotic intervention strategies—such as vaccines, probiotics, targeted antimicrobial peptides, or phage therapy—to improve eradication rates, reduce side effects, and address the global threat of antimicrobial resistance [1–3].