The treatment of Helicobacter pylori infection is in a state of flux as 
traditional therapies fail and new therapies do not achieve the 90% eradication 
rates desired by clinicians. Triple therapy, which has been the mainstay of 
treatment in many countries over the last decade, now has suboptimal results in 
many parts of the world. A number of new treatments have been described with 
variable success in different parts of the world. In this article, the 
fundamentals of treatment for H. pylori treatment are reviewed and new treatment 
algorithms are proposed for regions of the world where triple therapy is 
failing. Sequential therapy and quadruple therapy (either bismuth-based or 
non-bismuth-based) are the best current options to replace initial treatment 
with triple therapy. When initial treatment fails, salvage treatments using 
rifabutin and levofloxacin are the best options. With knowledge of local 
resistance patterns and with meticulous confirmation of eradication with 
retreatment, most H. pylori infections can be successfully eradicated.