Helicobacter pylori antibiotic resistance rises across Europe

A large European study coordinated by Spanish researchers from CIBEREHD, the Instituto de Investigación Sanitaria Biogipuzkoa and the University of the Basque Country analyzed 216 investigations involving more than 170,000 patients from 31 countries between 1990 and 2024. The analysis shows primary resistance to clarithromycin has reached 24% and to levofloxacin 21% in the 2020‑2024 period, both exceeding the 15% threshold used in European treatment guidelines. Metronidazole resistance is even higher at 33%, while resistance to amoxicillin, tetracycline and rifampicin remains low.

These resistance levels threaten the effectiveness of standard Helicobacter pylori eradication regimens, which combine several antibiotics with a proton‑pump inhibitor. The authors stress that continuous surveillance is essential to adapt therapeutic strategies and maintain successful treatment outcomes, given the bacterium’s role as a major cause of gastric ulcers and its classification by the WHO as a Group 1 carcinogen.