Abstract
Helicobacter pylori (HP) infection is the commonest chronic bacterial infection of man. Most gastroduodenal ulcers are due to HP infection. In addition, HP infection is considered to be the main aetiological factor of gastric carcinogenesis. For more than 30 years antibiotic therapy has been very effective in eradicating HP. Both antibiotic resistance and insufficient adherence to treatment threaten the efficacy of eradication therapy. Secondary antimicrobial resistance rates of H. pylori as published by the German National Reference Centre show the drastic increase of antibiotic resistance. If the initial standard triple therapy fails, the secondary resistances rise up to about 62 % for metronidazole, 66 % for clarithromycin and 21 % for quinolones. Therefore we should aim at a highly effective first-line treatment strategy that takes into account any risk of antibiotic resistance in an individual patient. Adherence to therapy and eradication efficacy will have to be monitored even more carefully in the future.
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