Liou JM, et al. - Researchers here focussed on the concerns regarding the rising prevalence of antibiotic resistance and the long-term safety following eradication therapy in the management of Helicobacter pylori (H. pylori) infection. Observations revealed an increase in the prevalence of clarithromycin, levofloxacin, and metronidazole resistance of H. pylori to 21%, 27%, and 45%, respectively, in the Asia-Pacific region. Excellent eradication rate in the first-line treatment could be achieved reliably with personalized treatment guided by susceptibility testing but it is costly and not widely available. An alternative suggested strategy is population-specific empirical therapy according to the local prevalence of antibiotic resistance. The recommended second-line rescue therapy is levofloxacin-based therapy and bismuth quadruple therapy. For refractory H. pylori infection, the preferred treatment is susceptibility testing or genotypic resistance guided therapy, but empirical therapy may be an acceptable alternative. Eradication of H. pylori results in short-term perturbation of gut microbiota. Restoration of the diversity of gut microbiota can be observed months following eradication therapy, but the speed of recovery differs with regimens. Restoration to basal states may occur in the short-term increases of antibiotic resistance of Escherichia coli and Klebsiella pneumoniae months following H. pylori eradication.