Table 2

Summary of treatment strategies

StatementLevel of evidenceGrade of recommendation
Proton pump inhibitor (PPI)-clarithromycin containing triple therapy without prior susceptibility testing should be abandoned when the clarithromycin resistance rate in the region is over 15–20%5D
In areas of low clarithromycin resistance, clarithromycin- containing treatments are recommended for first-line empirical treatment. Bismuth-containing quadruple treatment is also an alternative1aA
In areas of high clarithromycin resistance, bismuth-containing quadruple treatments are recommended for first-line empirical treatment. If this regimen is not available sequential treatment or a non-bismuth quadruple treatment is recommended1aA
The use of high-dose (twice a day) PPI increases the efficacy of triple therapy1bA
Extending the duration of PPI-clarithromycin-containing triple treatment from 7 to 10–14 days improves the eradication success by approximately 5% and may be considered1aA
PPI-clarithromycin-metronidazole (PCM) and PPI-clarithromycin-amoxicillin (PCA) regimens are equivalent1aA
Certain probiotics and prebiotics show promising results as an adjuvant treatment in reducing side effects5D
PPI-clarithromycin-containing treatments do not need to be adapted to patient factors except for dosing5D
After failure of a PPI-clarithromycin containing therapy, either a bismuth containing quadruple therapy of Levofloxacin containing triple therapy are recommended.1aA
Rising rates of Levofloxacin resistance should be taken into account2bB
After failure of second-line treatment, treatment should be guided by antimicrobial susceptibility testing whenever possible4A
The urea breath test or a laboratory based validated monoclonal stool test are both recommended as non-invasive tests for determining the success of eradication treatment. There is no role for serology1aA