HP infection is a common cause of peptic ulcer disease and gastric cancer. When choosing treatment for HP infection, a patient's previous antibiotic exposure should be considered to determine the most effective regimen. For first-line treatment, clarithromycin triple therapy should only be used in areas with low clarithromycin resistance and in patients without prior macrolide exposure. Bismuth quadruple therapy or concomitant therapy with a PPI, clarithromycin, amoxicillin and metronidazole are better first-line options for most patients. Salvage regimens after first-line treatment failure should avoid previously used antibiotics and may include bismuth quadruple therapy or levofloxacin depending