Antibiotic resistance is the major reason for Helicobacter pylori treatment failure, and the increasing frequency of antibiotic resistance is a challenge for clinicians. Resistance to clarithromycin and metronidazole is a particular problem. The standard triple therapy (proton pump inhibitor, amoxicillin, and clarithromycin) is no longer appropriate as the first-line treatment in most areas. Recent guidelines for the treatment of H. pylori infection recommend a quadruple regimen (bismuth or non-bismuth) as the first-line therapy. This treatment strategy is effective for areas with high resistance to clarithromycin or metronidazole, but the resistance rate inevitably increases as a result of prolonged therapy with multiple antibiotics. Novel potassium-competitive acid blocker-based therapy may be effective, but the data are limited. Tailored therapy based on antimicrobial susceptibility test results is ideal. This review discussed the current important regimens for H. pylori treatment and the optimum H. pylori eradication strategy.

中文翻译：

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抗生素耐药性时代的最佳幽门螺杆菌根除策略。

抗生素耐药性是幽门螺杆菌治疗失败的主要原因，而抗生素耐药性增加的频率对临床医生构成了挑战。对克拉霉素和甲硝唑的抗性是一个特别的问题。在大多数地区，标准的三联疗法（质子泵抑制剂，阿莫西林和克拉霉素）不再适合作为一线治疗。幽门螺杆菌治疗的最新指南感染推荐四联疗法（铋或非铋）作为一线治疗。这种治疗策略对克拉霉素或甲硝唑具有高耐药性的地区有效，但长期使用多种抗生素治疗的结果不可避免地会增加耐药率。基于钾竞争酸阻滞剂的新型疗法可能有效，但数据有限。根据抗菌药敏试验结果进行量身定制的治疗是理想的。这篇综述讨论了幽门螺杆菌治疗的当前重要方案和最佳的幽门螺杆菌根除策略。