Lay summary
Helicobacter pylori, a bacteria that lives in the lining of the stomach, is the most significant risk factor for stomach cancer, which remains a leading cause of cancer-related death globally. H. pylori and stomach cancer continue to disproportionately impact Māori and Pacific peoples in Aotearoa. When H. pylori is identified and treated, stomach cancer can be prevented. Of concern, the rates of successful eradication with commonly used antibiotic regimens is declining due to increasing antimicrobial resistance. To improve eradication, we will develop and validate new methodologies to test antibiotic susceptibility in H. pylori to guide antibiotic prescribing. We will assess these methods in clinical trials to determine if routine antibiotic resistance testing increases treatment efficacy. This transformative approach to the treatment of H. pylori in Aotearoa has the potential to increase the successful eradication of H. pylori, improve stomach cancer rates and health equity, and reduce inappropriate prescribing of antibiotics.