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 Development of H. pylori therapy differs from other infectious diseases. Since the advent of antibiotics, infectious diseases therapy has been susceptibility based, whereas most H. pylori treatment guidelines recommend susceptibility testing only after two empiric therapy failures. Increased penicillin resistance in the 1970s prompted rapid changes in recommendations and the development of antimicrobial surveillance programme to regularly update recommendations thus allowing empirical therapies to remain effective.1 Despite increasing resistance, H. pylori treatment guidelines have continued to recommend increasingly ineffective therapies and most new empiric therapies consist of variations using those same drugs (eg, sequential therapy). Treatment success has focused on comparisons between regimens irrespective of cure rates and without consideration of the antibiotic susceptibility profile of the infection, thus producing illusions of success. For example, sequential therapy consists of 5 days of dual proton pump inhibitor (PPI)–amoxicillin therapy followed by 5 days of PPI–clarithromycin and metronidazole triple therapy (Bazzoli’s triple therapy).2 Interestingly, sequential therapy …

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关于幽门螺杆菌临床试验和治疗指南的错觉

确定可靠的幽门螺杆菌根除疗法已被证明是困难的，部分原因是幽门螺杆菌短暂暴露于常用的抗菌剂，如大环内酯类、硝基咪唑或喹诺酮类，通常会导致耐药性（旁观者效应）。大多数治疗研究和荟萃分析都存在阻碍普遍性的重大缺陷，从而使可靠的治疗建议和指南成为一种错觉（框 1）。框 1 ### 幽门螺杆菌治疗错觉 幽门螺杆菌治疗的发展不同于其他传染病。自抗生素问世以来，传染病治疗一直以药敏为基础，而大多数幽门螺杆菌治疗指南建议仅在两次经验性治疗失败后进行药敏试验。1970 年代青霉素耐药性增加促使推荐的快速变化和抗菌素监测计划的发展，以定期更新推荐，从而使经验疗法保持有效。 1 尽管耐药性增加，幽门螺杆菌治疗指南继续推荐越来越无效的疗法和大多数新疗法经验疗法包括使用相同药物的变化（例如，序贯疗法）。治疗成功主要集中在方案之间的比较，而不考虑治愈率，也没有考虑感染的抗生素敏感性，从而产生成功的错觉。例如，