With the increasing rate of H. pylori (Hp) resistance to metronidazole and clarithromycin in recent years, the eradication rate of standard triple therapy in most regions of the world has been far below 80% and unacceptable. The Hp eradication rate of standard triple therapy in China is also decreasing year by year. According to the literature review, before 2004, the eradication rate of standard triple therapy in China was 88.5%; from 2005 to 2009, the eradication rate of standard triple therapy decreased to 77.66%; and after 2010, the eradication rate of standard triple therapy was only 71.13%. A multicenter study in China in 2009 showed that metronidazole, clarithromycin and levofloxacin had high Hp resistance rates of 68.55%, 22.11% and 26.25%, respectively, while amoxicillin and tetracycline had lower resistance rates of 1.26% and 2.29%. The findings of Hp resistance rates in the southeastern coastal region of Fujian, China in 2012 were similar, with higher rates of clarithromycin, metronidazole and levofloxacin resistance (21.5%, 95.4% and 20.6%), and lower rates of amoxicillin and furazolidone resistance (both 0.1%). The monitoring of Hp resistance rate of commonly used antibiotics in Jiangxi region also showed that the resistance rate of metronidazole was 37.7% in 1996 and increased to 87.43% in 2011; the resistance rate of clarithromycin also increased from 9.3% to 22.29%. The lack of strict clinical indications for eradication and irregular treatment regimens are important reasons for the development of Hp resistance. From 1999 to the present, our Hp group has organized four national consensus on the diagnosis and treatment of Hp infection, which effectively standardized the diagnosis and treatment of Hp by clinicians. The latest fourth consensus was released in September 2012 and has been presented more than 100 times at various meetings across China so far. The new consensus further clarified the indications for Hp eradication, adjusted the composition of eradication regimens, and recommended the bismuth quadruple regimen with a higher eradication rate as the preferred regimen for Hp eradication, with the duration of treatment extended to 10 d or 14 d. However, according to our recent national questionnaire survey, the Hp diagnosis and treatment of primary care physicians still needs to be further standardized, and most primary care physicians still use the triple regimen with a lower eradication rate as the preferred regimen. However, according to our recent national survey, the majority of primary care physicians still use triple therapy with low eradication rate as the preferred option, and the consensus rate needs to be improved. Strategies to improve the eradication rate of Hp infection China is a developing country with a large population, high infection rate, and high resistance rate of clarithromycin, metronidazole, and quinolones antibacterial drugs. In the face of the increasingly serious situation, how should we improve the eradication rate of Hp infection? 1, pay attention to the role of bismuth in Hp eradication program In 2007, a study in China showed that the standard triple therapy (proton pump inhibitor + clarithromycin + amoxicillin) combined with bismuth could increase the eradication rate from 75.0% to 85.7%. It was also shown that the combination of bismuth was effective in overcoming levofloxacin resistance. In addition, a meta-analysis has shown that bismuth is used for short-term eradication of Hp treatment with high safety and good compliance. In 1999, Hainan consensus recommended replacing metronidazole with furazolidone, which has a high resistance rate, and in 2012, Jinggangshan consensus recommended using furazolidone-containing initial and remedial quadruple regimens. A multicenter, randomized, parallel-controlled clinical study of Hp eradication with furazolidone-containing therapy in Jiangxi showed that the eradication rate of bismuth-containing furazolidone quadruple 7-d regimen could reach 82.8%, and 86.1% after extending the regimen to 10-d. The results of a national multicenter study of bismuth-containing furazolidone also showed that the eradication rate of 10-d furazolidone quadruple regimen (86.56%) was more satisfactory. In 2010, Graham, editor-in-chief of Helicobacter, noted that remedial treatment with bismuth-containing and furazolidone quadruplexes in patients who had failed multiple eradication regimens had little to no failure. In the early 1990s, tetracycline became available for Hp eradication therapy. In recent years, with the increasing rate of Hp resistance year by year, tetracycline-containing Hp eradication regimens have received renewed attention. 2011, Lancet published a multicenter European clinical study of Hp eradication with 10-d bismuth quadruple therapy, which showed that 10-d quadruple therapy had a better Hp eradication rate (80% in ITT analysis and 93% in PP analysis) than the standard triple group (55% in ITT analysis and 70% in PP analysis 70%). A prospective study in China also showed that Hp eradication remedial therapy with a quadruple regimen containing a proton pump inhibitor, bismuth, tetracycline and furazolidone had an ITT eradication rate of 91.7%. 3, the impact of CYP2C19 gene polymorphism on Hp eradication It is currently believed that there are three gene polymorphisms of CYP2C19, namely, purex strong metabolism (HomEM), heterozygous strong metabolism (HetEM) and weak metabolism (PM). pH value in the stomach has a certain influence on antibiotic sensitivity and Hp eradication rate, and clinical practice should choose the one less influenced by CYP2C19 polymorphism Proton pump inhibitors. In recent years, probiotic adjuvant therapy has also been gaining attention. A study in Japan showed that the standard triplet regimen combined with probiotic therapy can significantly improve the eradication rate. A meta-analysis conducted by our hospital (including 57 randomized controlled studies) also showed that probiotic adjuvant therapy can not only improve the eradication rate, but also effectively reduce the adverse effects of conventional regimens. However, differences in different types of probiotics, dosing regimens and duration of therapy can have an impact on treatment outcomes and are issues that need attention in future studies. Summary: China is a developing country with a large population, high infection rate, high resistance rate of clarithromycin, metronidazole, and quinolones antimicrobials, and irregular application of Hp eradication regimens by primary care physicians is common. Therefore, there is a long way to go to promote and popularize the fourth consensus.