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幻觉

事实证明，确定可靠的幽门螺杆菌根除疗法很困难，部分原因是幽门螺杆菌短暂暴露于常用的抗菌剂（例如大环内酯类，硝基咪唑或喹诺酮类）经常会产生耐药性（旁观者效应）。大多数治疗研究和荟萃分析都包含一些主要缺陷，这些缺陷会阻止普遍性，从而使可靠的治疗建议和指南成为一种幻觉（方框1）。方框1 ###幽门螺杆菌治疗的幻觉幽门螺杆菌疗法的发展与其他传染病有所不同。自从抗生素问世以来，传染病的治疗一直以药敏性为基础，而大多数幽门螺杆菌治疗指南建议仅在两次经验治疗失败后才进行药敏测试。在1970年代，青霉素耐药性的增加促使建议快速变化，并制定了抗菌监测计划以定期更新建议，从而使经验疗法保持有效。1尽管耐药性有所提高，但幽门螺杆菌治疗指南仍继续建议无效的治疗方法，并且大多数新方法经验疗法包括使用那些相同药物的变种（例如，序贯疗法）。治疗成功的重点在于不考虑治愈率且不考虑感染的抗生素敏感性的方案之间的比较，因此产生了成功的幻觉。例如，