Bismuth containing triple therapy continues to reach high eardication rates (worldwide 80-85%). In the past, side effects and diminished patient compliance were considered to be major drawbacks of this therapy. Another point of concern was the marked decline of eradication efficacy in case of metronidazole resistance. Therefore dual therapy with an antibiotic and proton pump inhibitor was introduced. This therapy has less side effects. No resistance to anoxicillin has been reported so far, despite worldwide use of this antibiotic. Unfortunately the eradication rates vary substantially in the literature (0%~90%) and confirmation of eradication results in a large patient group is urgently needed. At present short courses of low dose triple therapy containing a proton pump inhibitor and two antibiotics have also shown to be very successful. However, only few data are available. Quadruple therapy, consisting of a proton pump inhibitor and classical triple therapy seems to garantuee eradication in about 90%~95% and may overcome the metronidazole resistance.
