Figure 2.

Biological attributes of resistance in H. pylori. The figure shows the biological attributes that drive antibiotic resistance in the H. pylori species (red stars denote the possibility of resistance mutation). It comprises mainly structural changes in genetic sequences that disrupt the cellular activity of antibiotics by altering the drug target (1–3), inhibiting drug activation within the cells (4), biofilm formation (consisting of a matrix of polysaccharides that constitute a multifactorial barrier to drug penetration and activity) (5), reduced drug uptake and increased drug efflux (6), or coccoid formation that generates ultrastructural and metabolic changes that prevent cellular penetration and activity of antibiotic molecules (7). All these attributes are not mutually exclusive but possibly coexist in different strains, jointly leading to three patterns of resistance: single drug resistance (SDR), multidrug resistance (MDR), and heteroresistance (HR). Reproduced with permission from ref,¹⁵ © Tshibangu-Kabamba E (2021).