Current international consensuses on Helicobacter pylori eradication
therapy recommend that only regimens that reliably produce eradication rates of ⩾90% should be used for empirical treatment. The Real-world Practice & Expectation of Asia-Pacific Physicians and Patients in Helicobacter Pylori Eradication Survey also showed that the accepted minimal eradication rate in H. pylori-infected patients was 91%. According to efficacy prediction model, the per-protocol eradication rates of 7-day and 14-day standard triple
therapies fall below 90% when
clarithromycin resistance rate ⩾5%. Several strategies including
bismuth-containing, non-
bismuth-containing quadruple
therapies (including sequential, concomitant, hybrid and reverse hybrid
therapies), high-dose dual
therapy and
vonoprazan-based triple
therapy have been proposed to increase the eradication rate of H. pylori
infection. According to efficacy prediction model, the eradication rate of 14-day concomitant
therapy, 14-day hybrid
therapy and 7-day
vonoprazan-based triple
therapy is less than 90% if the frequency of
clarithromycin-resistant strains is higher than 90%, 58% and 23%, respectively. To meet the recommendation of the consensus report and patients' expectation, local surveillance networks for resistance of H. pylori to
clarithromycin are required to select appropriate eradication regimens in each geographic region. In areas with low (<5%)
clarithromycin resistance (e.g. Sweden, Philippine, Myanmar and Bhutan), 7-day and 14-day standard triple
therapies can be adopted for the first-line treatment of H. pylori
infection with eradication rates of ⩾90%. In areas with high (⩾5%)
clarithromycin resistance (most other countries worldwide) or unknown
clarithromycin resistance, 14-day hybrid, 14-day reverse hybrid, 14-day concomitant and 10- to 14-day
bismuth quadruple
therapy can be used to treat H. pylori
infection.