I read with great interest the Toronto consensus for the treatment of Helicobacter pylori infection in adults.1 The authors of the consensus clearly summarized the recommendations how to use population resistance information for directing the best treatment for successful H pylori eradication. When discussing the bismuth quadruple therapy, the authors recommended tetracycline as part of the regimen; however, this drug is unavailable in many countries. We recommend in this situation replacing tetracycline with doxycycline.