Helicobacter pylori Eradication in the Era of Antibiotic Resistance: From Universal Regimens to Precision-Guided Management

Helicobacter pylori (H. pylori) infection represents a major global health challenge and a leading cause of peptic ulcer disease and gastric cancer. The increasing prevalence of antimicrobial resistance has progressively reduced the effectiveness of traditional empirical eradication regimens, highlighting the need for more individualized treatment approaches. This review evaluates the evolving transition from empirical therapy toward precision-guided H. pylori management by integrating current evidence on resistance epidemiology, determinants of eradication failure, advances in molecular diagnostics, and susceptibility-guided treatment strategies. Contemporary and emerging therapeutic approaches are evaluated in the context of changing resistance patterns, with emphasis on their clinical applicability and potential contributions to treatment optimization. The review also addresses the practical challenges that continue to limit implementation of personalized management, including restricted access to resistance testing, infrastructure limitations, economic constraints, and global disparities in healthcare resources. Furthermore, emerging developments in rapid diagnostics, resistance surveillance, and data-driven treatment selection are considered as components of future management frameworks. Overall, the evidence supports moving away from one-size-fits-all empirical therapy toward targeted treatment based on local resistance patterns and epidemiological trends. Expanding access to effective diagnostics and optimizing treatment selection will be essential for improving eradication outcomes and preserving the long-term effectiveness of available antimicrobial agents.