Data are available such that choice of Helicobacter pylori therapy for an individual patient can be reliably predicted. Here treatment success is defined at a cure rate of 90% or greater. Treatment outcome in a population or a patient can be calculated based on the effectiveness of a regimen for infections with susceptible and with resistant strains coupled with knowledge of the prevalence of resistance (i.e., based on formal measurement, clinical experience, or both). We provide the formula for predicting outcome and we illustrate the calculations. Because clarithromycin-containing triple therapy and 10 day sequential therapy are now only effective in special populations they are considered obsolete; neither should continue to be used as empiric therapies (i.e., 7 and 14 day triple therapies fail when clarithromycin resistance exceeds 5% and 15%, respectively and 10-day sequential therapy fails when metronidazole resistance exceeds 20%). Therapy should be individualized base on prior history and whether the patient is in a high risk group for resistance. The preferred choices for Western countries are 14 day concomitant therapy, 14 day bismuth quadruple therapy, and 14 day hybrid sequential-concomitant therapy. We also provide details regarding the successful use of fluoroquinolone-rifabutin-, and furazolidone-containing therapies. Finally, we give recommendations for efficient development (i.e., identification and optimization) of new regimens as well as how to prevent or minimized failures. The trial and error approach for identifying and testing regimens frequently resulted in poor treatment success. The approach described allows outcome to be predicted and should simplify treatment and drug development.
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