Peningkatan Resistensi Antibiotik Clarithromycin dan Metronidazole terhadap Helicobacter pylori dan Tinjauan Implikasinya terhadap Terapi Peptic Ulcer Disease

Peptic Ulcer Disease (PUD) remains a significant global health problem, with a substantial proportion of cases associated with Helicobacter pylori infection. The success of eradication therapy depends largely on antibiotic effectiveness, particularly that of clarithromycin and metronidazole. However, increasing H. pylori resistance to these antibiotics has become a major challenge, leading to treatment failure and reduced eradication rates. This review aims to examine current H. pylori resistance patterns to clarithromycin and metronidazole and their implications for eradication therapy. Evidence from various studies indicates that clarithromycin resistance reduces the efficacy of standard triple therapy consisting of a proton pump inhibitor (PPI), clarithromycin, and either amoxicillin or metronidazole. Metronidazole resistance also contributes to eradication failure, although its impact may be partially overcome by adjusting the dose or extending treatment duration. Therefore, therapeutic regimens should be selected based on local resistance patterns and rational antibiotic use. Alternative regimens, such as bismuth-based quadruple therapy, may be considered in regions with high resistance rates. Continuous surveillance of H. pylori antibiotic resistance is essential to improve eradication success and clinical outcomes in patients with PUD.