Molecular Detection Technologies for Helicobacter pylori Antibiotic Resistance: Current Status and Clinical Implications

Helicobacter pylori (H. pylori) infects approximately half of the global population and is closely linked to chronic gastritis, peptic ulcers, and gastric cancer. Antibiotic resistance has become a major global health concern with marked regional variations, severely undermining empirical treatment efficacy. Resistance mechanisms primarily involve target gene mutations, efflux pump overexpression, and altered membrane permeability. This review summarizes resistance mechanisms of commonly used antibiotics against H. pylori, along with diagnostic approaches ranging from phenotypic to molecular methods, the latter offering faster and more precise mutation detection, yet limited by high costs and invasive sampling. Treatment has shifted from clarithromycin-based triple therapy to bismuth-containing quadruple and potassium-competitive acid blocker-based regimens. However, susceptibility-guided therapy faces implementation barriers, and empirical regimens remain prevalent. Future directions emphasize affordable multiplex molecular platforms, resistance surveillance networks, artificial intelligence-driven predictive models, and non-antibiotic adjunctive strategies. Integrating molecular diagnostics with antimicrobial stewardship to transition from empirical to precision-based management is critical for improving eradication rates and curbing further resistance spread.