H pylori is a genetically diverse organism that can quickly develop resistance to antibiotics. This factor, together with its location in the stomach mucus, makes H pylori a difficult organism to treat. Initial treatment of this bacterium is successful more than 80% of the time, but with growing resistance, initial treatment success rates are falling below 80% in many parts of the United States. It is recommended that, after two unsuccessful attempts to treat H pylori, upper gastrointestinal endoscopy with gastric biopsy for bacterial culture and antimicrobial resistance testing be sought to guide further treatment. In addition to the new antibiotic treatments that are being developed for people with multiresistant strains, several companies are looking at the prospects of a therapeutic H pylori vaccine that would easily treat everyone infected with this bacterium. Therapeutic vaccines are currently being studied in animal models with some success [82,83].
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