Summary Since the discovery of Helicobacter pylori, its eradication has been one of the most important global challenges in gastroenterology. In many places the prevalence of the microorganism’s primary resistance to different antibiotics is unknown. Consequently, antibiotics are used empirically in daily practice. Tests to verify eradication are normally not used, leaving the effectiveness of treatment unknown as well. Knowledge of these two factors could make it possible to identify those still infected after treatment as well as help physicians make better informed choices of appropriate rescue therapies. Lack of information on pre-treatment resistance is a problem that makes it impossible to measure the impact of pretreatment resistance on therapeutic failure. At the global level, standard triple therapy has lost the effi cacy it once had, while sequential therapy is not equally effective in every part of the world, especially in those regions where high resistance to clarithromycin and methronidazolee exists. Treatment schemes with levofl oxacin triple therapies have proven effective as fi rst line therapies and/or rescue treatments. Nevertheless, each region should develop its own treatment schemes based on the results of local susceptibility tests and pharmacogenomic studies.