As a general rule for the treatment of infectious diseases, clinicians should prescribe anti-H. pylori regimens that have a per-protocol eradication rate ≥ 90%. However, the eradication rate of the standard triple therapy recommended by the Maastricht III Consensus Report has generally declined to unacceptable levels (i.e., 80% or less) recently. The reasons for this fall in efficacy with time are uncertain but may relate to the increasing incidence of clarithromycin-resistant strains of H. pylori, poor compliance, and rapid metabolism of PPI. Recently, several treatment regimens have emerged to cure H. pylori infection. The novel first-line anti-H. pylori therapies in 2011 include sequential therapy, concomitant quadruple therapy, hybrid (dual-concomitant) therapy, and bismuth-containing quadruple therapy.

After the failure of standard triple therapy, the Maastricht III Consensus Report recommended a bismuth-containing quadruple therapy regimen comprising a PPI, bismuth, metronidazole, and tetracycline as second-line therapy. Recently, a triple therapy with the combination of a PPI, levofloxacin, and amoxicillin has been proposed as an alternative to the standard rescue therapy and can achieve a higher eradication rate than bismuth-containing quadruple therapy in some regions. Most guidelines suggest that patients requiring third-line therapy should be referred to medical center and treated according to the antibiotic susceptibility test. However, it has been reported that the sensitivity of culture is less than 60%. Additionally, in vitro antimicrobial sensitivity does not necessarily lead to eradication in vivo and vice versa.

The main focus of the special issue will be on the recent advances in the treatment of H. pylori infection. The special issue will review the novel first-line eradication regimens with a per-protocol eradication rate exceeding 90%. In addition, the emerging rescue therapy for the second-line and third-line therapies will be introduced. Potential topics include, but are not limited to:

• Pathogenesis of H. pylori infection
• Current indications for H. pylori eradication therapy
• The reasons for eradication failure
• First-line anti-H. pylori therapy
• Emerging second-line anti-H. pylori therapy
• Emerging third-line anti-H. pylori therapy

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