The VI Spanish Consensus Conference on treatment of Helicobacter pylori infection met in June 2026. Sixteen experts ran a systematic literature search and drafted 25 recommendations, which went through anonymous Delphi voting, with GRADE used to rate the certainty of evidence and the strength of recommendations.
Its starting premise is that a regimen used empirically should achieve a cure rate of at least 90%, and preferably higher. On that basis it recommends quadruple regimens both first line and as rescue. For first line, it recommends a 10-day regimen of a proton pump inhibitor with bismuth, tetracycline and metronidazole. After failure of that, it recommends a proton pump inhibitor with amoxicillin, levofloxacin and bismuth. Other rescue options are reviewed in detail.
This is a national consensus written for Spanish resistance patterns and product availability, and the abstract gives no trial data for the individual recommendations. In India, clarithromycin and metronidazole resistance, and local access to bismuth and tetracycline, differ, and Indian recommendations have not changed as a result. The consensus supports the principle of choosing regimens with local cure rates above 90% and re-checking eradication.
- Choose a regimen your local data support at a cure rate of about 90% or better, not by habit.
- Where bismuth and tetracycline are available, a bismuth quadruple regimen is a reasonable first-line option to consider.
- Confirm eradication after treatment, at least 4 weeks after antibiotics and off acid suppression for a short period as per local protocol.
- Avoid repeating a regimen the patient has already failed.
- Ask about previous macrolide and fluoroquinolone exposure before choosing a rescue regimen.
Why it matters
It replaces the habit of using whatever triple therapy is to hand with an explicit cure-rate target.
Don't overread it
This is a Spanish expert consensus; it does not change Indian or international guidelines, and the abstract gives no trial results.
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