Sequential changes of antibiotic resistances of <i>Helicobacter pylori</i> in Taiwan from 2019 to 2024

BACKGROUND Antibiotic resistance significantly impacts the treatment failure rates of Helicobacter pylori (H. pylori) infections. AIM To investigate the trends in primary antibiotic resistance of H. pylori in Taiwan over the past six years. METHODS We conducted a retrospective analysis of H. pylori isolates from Taiwanese who had not undergone previous treatments (n = 1408), collected between January 1, 2019 and December 31, 2024. Susceptibility of these strains to amoxicillin, clarithromycin, levofloxacin, metronidazole, and tetracycline was tested using the Epsilometer test. We analyzed the trends in single and dual resistance profiles over the study period, and compared antibiotic resistance across different regions (northern, southern and eastern areas) of Taiwan. RESULTS The overall resistance rates for H. pylori to amoxicillin, clarithromycin, metronidazole, tetracycline, and levofloxacin in Taiwan were 1.3%, 18.0%, 31.0%, 0.8%, and 28.7%, respectively. Tetracycline resistance increased significantly from 0% in 2019 to 3.5% in 2024 (P value in χ 2 test for linear trend: < 0.001), while metronidazole resistance declined from 35.5% to 13.0% (P value in χ 2 test for linear trend: < 0.001). No significant changes of amoxicillin, clarithromycin and levofloxacin resistances were observed. The dual resistances to clarithromycin plus tetracycline, and metronidazole plus tetracycline both increased significantly from 0% to 1.7% from 2019 to 2024 (P value in χ 2 test for linear trend: < 0.05). Furthermore, no significant regional differences in resistance frequencies except for levofloxacin were detected. CONCLUSION Primary antibiotic resistance to tetracycline in H. pylori has increased in Taiwan from 2019 to 2024, while resistance to metronidazole has decreased during the same period. The dual resistance to clarithromycin plus tetracycline and metronidazole plus tetracycline both increased significantly.