The successful treatment rate of Helicobacter pylori is facing many challenges, mainly due to 
antimicrobial resistance as a result of antibiotics abuse. To assesse the burden of resistance‐associated 
treatment failure, the efficacy of culture‐based antimicrobial susceptibility was tested for all 
antimicrobial used as treatment guidelines for eradication of Helicobacter pylori infection. Methods: 
In this study, incidence of Helicobacter pylori infection in Minia University hospital was determined 
by testing a random sample of 40 patients undergoing upper gastrointestinal endoscopy for 
Helicobacter pylori infection. Then, the agar dilution method was used to determine the minimal 
inhibitory concentration of 6 alternative antibiotics, patterns of antimicrobial resistance and efficacy 
of commercial antibiotics in treatment of Helicobacter pylori infection. Results: Prevalence of 
Helicobacter pylori infection was 47.5% among our patients. Antibiotic resistance rates were 
alarmingly high, up to 100% in amoxicillin, rifampicin, and levofloxacin, 94.7% in tetracycline and 
clarithromycin, and 89.4% in metronidazole. Discussion: This Study showed unprecedented 
antimicrobial resistance rates of Helicobacter pylori. New alternative treatment regimens should be 
considered and investigated to replace the current ineffective therapies.