Management of Helicobacter pylori infection increasingly requires clinicians to navigate antimicrobial resistance, molecular susceptibility testing, and expanding therapeutic options simultaneously. The central challenge is no longer simply whether empirical or susceptibility-guided therapy is preferable, but whether diagnostic information can be translated into an effective treatment that is actually available within a given healthcare system. We propose Diagnostic–Therapeutic Readiness as a practical conceptual framework for this problem. Diagnostic readiness is the capacity to generate timely, reliable, and clinically actionable susceptibility information before treatment, whereas therapeutic readiness is the capacity to deliver an effective eradication pathway despite microbiological uncertainty. Their alignment produces four clinically distinct readiness states, ranging from precision-guided care when both are high to capacity-building priorities when both are limited. The framework does not rank individual tests or regimens and is not a treatment algorithm. It is intentionally simplified and remains unvalidated. Future research should operationalise readiness, test whether greater alignment improves eradication and antimicrobial stewardship, and determine how health systems move between readiness states as diagnostics and therapies evolve.