The eradication rate of H. pylori after an initial course of antibiotic treatment is only 70%. It is therefore essential to inform patients from the onset that a follow-up verification of eradication will be needed 4 to 6 weeks after the first course of treatment and a second or even a third course may be required. After two treatment failures, antibiotic treatment should be adapted to the specific bacterial sensitivity, which necessitates endoscopy with biopsy and culture. The recent increase in bacterial resistance to clarithromycin will probably lead to modifications in the French guidelines within the next 2 years. Recognition of the carcinogenic role of H. pylori has increased the indications for bacterial eradication.