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Helicobacter pylori  is the major component of the gastric microbiome of infected individuals and one of the aetiological factors of chronic gastritis, peptic ulcer disease and gastric cancer. The increasing resistance to antibiotics worldwide has made the treatment of  H. pylori  infection a challenge. As a way to overhaul the efficacy of currently used  H. pylori  antibiotic-based eradication therapies, alternative treatment strategies are being devised. These include probiotics and prebiotics as adjuvants in  H. pylori  treatment, antimicrobial peptides as alternatives to antibiotics, photodynamic therapy ingestible devices, microparticles and nanoparticles applied as drug delivery systems, vaccines, natural products, and phage therapy. This review provides an updated synopsis of these emerging  H. pylori  control strategies and discusses the advantages, hurdles, and challenges associated with their development and implementation. An effective human vaccine would be a major achievement although, until now, projects regarding vaccine development have failed or were discontinued. Numerous natural products have demonstrated anti- H. pylori  activity, mostly  in vitro , but further clinical studies are needed to fully disclose their role in  H. pylori  eradication. Finally, phage therapy has the potential to emerge as a valid alternative, but major challenges remain, namely the isolation of more  H. pylori  strictly virulent bacterio(phages).

Helicobacter pylori infection: from standard to alternative treatment strategies