**Abstract**

This chapter aims at studying the microbial virulence determinants and markers of *Helicobacter pylori (Hp*), the molecular diagnostic of *Hp*, the growing antibiotic resistance with the related problem of heteroresistance, the genotypic resistance to antimicrobials compared with the phenotypic methods and the new treatment strategies for *Hp* eradication also evaluating new antimicrobial agents (furazolidone, vonoprazan). The virulence markers cover an important area in *Hp* pathology due to the correlation between these and the different diseases. The *Hp* molecuar diagnosis is fast, accurate and reliable over the traditional methods that are expensive and time- consuming. Therapy regimens used over the past decade are declining in efficacy being the *Hp* treatment bedevilled by drug-resistant strains. New treatment strategies are under study worldwide. The determination of the genetic resistance to antibiotics is very useful when used directly on gastric biopsies for prediction of antibiotics ineffectiveness or for addressing changes in previous treatments.

**Keywords:** *Helicobacter pylori* infection, virulence markers, molecular diagnostic, heteroresistance, antibiotic resistance, updated treatment strategies
