The eradication of Helicobacter pylori not only heals peptic ulcers but also prevents their recurrence and reduces the risk of
development of gastric cancer and other H. pylori-associated disorders. H. pylori eradication heals gastritis and may prevent the spread of
infection, reducing the future costs required for the treatment of subsequent H. pylori-associated diseases. There are various guidelines
for the management of H. pylori infection worldwide, such as the guidelines of the American College of Gastroenterology, Maastricht
IV, the Second Asia-Pacific Consensus Conference, and Japan. The Japanese health insurance system approved H. pylori eradication
therapy for H. pylori-related chronic gastritis in 2013. Triple therapy regimens comprising 1 proton pump inhibitor and 2 antimicrobial
agents such as amoxicillin, clarithromycin, metronidazole, levofloxacin, or tetracycline have been widely used to eradicate this bacterium.
The rate of successful eradication has declined owing to the increased rate of drug resistance stemming from the wide usage of antibiotics.
This issue is of particular relevance with regard to clarithromycin. In worldwide, clarithromycin-based triple therapy should be
abandoned, as it is no longer effective. Quadruple therapy and sequential therapy are reasonable alternatives for initial therapy. First-line
treatment should be recommended on the basis of an understanding of the local prevalence of H. pylori antimicrobial resistance.