Vonoprazan-based triple therapy for Helicobacter pylori resistant to first-line regimens: A guideline-compliant 14-day multicenter study in Egypt
Abstract
BACKGROUND
The global rise in antibiotic resistance has severely compromised the efficacy of first-line Helicobacter pylori therapies, particularly in Egypt, where dual resistance to clarithromycin and levofloxacin exceeds 55 % and dual clarithromycin-metronidazole resistance occurs in over 35 %. Vonoprazan, a potassium-competitive acid blocker, provides more potent and sustained acid suppression than proton pump inhibitors, enhancing eradication outcomes. This study evaluated a 14-day vonoprazan-based triple therapy for dual-resistant H. pylori infections.
METHODS
This multicenter, single-arm cohort study was conducted between January 2023 and January 2024. A total of 300 patients with endoscopically confirmed H. pylori infection and dual resistance to clarithromycin and levofloxacin were enrolled. Patients received vonoprazan 20 mg twice daily, amoxicillin 1 g twice daily, and metronidazole 500 mg twice daily for 14 days. Eradication was assessed by monoclonal stool antigen testing at 4 weeks and 3 months per Maastricht VI guidelines. Endoscopic subgroups were analyzed histologically per Sydney criteria. Symptoms, laboratory indices, and safety were monitored.
RESULTS
Per-protocol eradication was 89.5 % (255/285) and intention-to-treat eradication was 82 % (246/300). Efficacy was consistent across endoscopic subgroups (atrophic gastritis 90 %; peptic ulcer 87 %; gastric polyps 83 %; all p > 0.15). Symptom prevalence markedly decreased at 3 months: abdominal pain (79-7 %),…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 300 participants or records.
Read the paper
Related studies
- Penicillins for Treatment of Pneumococcal Pneumonia: Does In Vitro Resistance Really Matter?
- Thiophenes—Naturally Occurring Plant Metabolites: Biological Activities and In Silico Evaluation of Their Potential as Cathepsin D Inhibitors
- Inhalable Mannosylated Rifampicin–Curcumin Co-Loaded Nanomicelles with Enhanced In Vitro Antimicrobial Efficacy for an Optimized Pulmonary Tuberculosis Therapy
- Development and validation of microbial bioassay for quantification of Levofloxacin in pharmaceutical preparations
- GC-MS Analysis and Biomedical Therapy of Oil from n-Hexane Fraction of Scutellaria edelbergii Rech. f.: In Vitro, In Vivo, and In Silico Approach
- Propranolol, chlorpromazine and diclofenac restore susceptibility of extensively drug-resistant (XDR)-Acinetobacter baumannii to fluoroquinolones
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.