Vaccine against Helicobacter pylori: fact or fiction?

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Abstract
The increased prescription of antibiotics for H pyloriinfection has encouraged the emergence of antibiotic resistant strains. Indeed, the efficacy of current therapies rarely exceeds 90%, and strains isolated after treatment failure often show resistance.9 Resistance to metronidazole is already high in developed countries, and resistance to clarithromycin is increasingly evident. A survey of resistance conducted over five years in Ireland showed that resistance to metronidazole and clarithromycin increased from 32% to 46% and from 5.3% to 8.6%, respectively.10 Because metronidazole has been available for decades before being used against H pylori, this rapid evolution suggests that the selection pressure on H pylorideveloped once antibiotics were prescribed in association with antisecretory agents. If this speculation is correct, the number of patients treated for H pylori infection may impact directly on the development of resistance, and accumulated treatment failure may result in the enrichment of the human reservoir with resistant strains. A direct impact on the efficacy of the current treatments may follow11 12 as evidence suggests that the main reservoir of H pylori is the human stomach. Indeed, passage from animals to humans does not seem to be an important mode of transmission, and H pylori does not resist well in the environment.