Helicobacter pylori: Routes of Infection, Antimicrobial Resistance, and Alternative Therapies as a Means to Develop Infection Control

Helicobacter pylori (H. pylori) is a Gram-negative, spiral-shaped bacterium that colonizes the
gastric epithelium and is associated with a range of gastrointestinal disorders, exhibiting a global
prevalence of approximately 50%. Despite the availability of treatment options, H. pylori frequently
reemerges and demonstrates increasing antibiotic resistance, which diminishes the efficacy of conventional
therapies. Consequently, it is imperative to explore non-antibiotic treatment alternatives to
mitigate the inappropriate use of antibiotics. This review examines H. pylori infection, encompassing
transmission pathways, treatment modalities, antibiotic resistance, and eradication strategies.
Additionally, it discusses alternative therapeutic approaches such as probiotics, anti-biofilm agents,
phytotherapy, phototherapy, phage therapy, lactoferrin therapy, and vaccine development. These
strategies aim to reduce antimicrobial resistance and enhance treatment outcomes for H. pylori infections.
While alternative therapies can maintain low bacterial levels, they do not achieve complete
eradication of H. pylori. These therapies are designed to bolster the immune response, minimize side
effects, and provide gastroprotective benefits, rendering them suitable for adjunctive use alongside
conventional treatments. Probiotics may serve as adjunctive therapy for H. pylori; however, their
effectiveness as a monotherapy is limited. Photodynamic and phage therapies exhibit potential in
targeting H. pylori infections, including those caused by drug-resistant strains, without the use of
antibiotics. The development of a reliable vaccine is also critical for the eradication of H. pylori. This
review identifies candidate antigens such as VacA, CagA, and HspA, along with various vaccine formulations,
including vector-based and subunit vaccines. Some vaccines have demonstrated efficacy in
clinical trials, while others have shown robust immune protection in preclinical studies. Nevertheless, each of the aforementioned alternative therapies requires thorough preclinical and clinical evaluation
to ascertain their efficacy, side effects, cost-effectiveness, and patient compliance.