Introduction
Identification of reliable Helicobacter pylori eradication therapy has proved difficult, in part because brief exposure of H. pylori to commonly used antimicrobials such as macrolides, nitroimidazoles or quinolones often results in resistance (bystander effect). Most treatment studies and meta-analyses contains major flaws preventing generalisability that making reliable treatment recommendations and guidelines an illusion (box 1).
Box 1
Helicobacter pylori treatment illusions
Most apparently well done treatment studies and meta-analyses are valid.
Studies reporting one regimen as superior to another can generally be believed.
Meta-analyses identifying the best H. pylori treatment regimen can generally be believed.
Treatment results without susceptibility testing are generally valid.
High overall cure rates validate use of successive low cure rate first, second and third-line treatments.
Increasing the number of antibiotic to 3 or 4 (eg, concomitant or quintuple therapies) is a rational approach to overcoming resistance.
Commercially available regimens have generally been optimised.
Development of H. pylori therapy differs from other infectious...
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