Clinical Gastroenterology and Hepatology; January 2026 Comparative Effectiveness of Empiric Treatment for Helicobacter pylori in a Large, Diverse Population in the United States

This comprehensive study evaluates the success rates of various antibiotic combinations used to eliminate H. pylori infections within a diverse American population. The research highlights that four-drug regimens, specifically concomitant and bismuth-based quadruple therapies, serve as the most effective initial treatments and maintain their potency over time. Crucially, the data suggests that prior antibiotic exposure and the repetition of failed drug cycles significantly diminish success, particularly during secondary "salvage" attempts. Ultimately, the authors advocate for a personalized prescribing strategy that avoids redundant medications and carefully considers a patient's medical history to overcome bacterial resistance.