Dual therapy with vonoprazan and low-dose amoxicillin had similar efficacy to triple-drug treatment for the eradication of Helicobacter pylori , according to study results published in Gut.

The investigators examined whether combination treatment of vonoprazan and low-dose amoxicillin might be an effective first-line treatment for H pylori compared with vonoprazan-based triple therapy. A total of 335 patients (aged 26-89 years; 85% men) who tested positive for H pylori infection between 2018 and 2019 were randomly assigned to receive either dual therapy (20 mg vonoprazan and 750 mg amoxicillin twice daily; n=168) or triple therapy (dual therapy plus 200 mg clarithromycin twice daily; n=167) for 7 days.

The rate of H pylori eradication was similarly effective in the intention-to-treat analysis (P =.203) for the dual (84.5%; 95% CI, 78.2%-89.6%) and triple (89.2%; 95% CI, 83.5%-93.5%) treatment groups and 87.1% and 90.2% (P =.372) by per-protocol analysis, respectively. Of the H pylori strains that infected the patient population, none were resistant to amoxicillin, but 23.8% of the dual and 25.1% of the triple therapy group was infected with clarithromycin-resistant strains. In the subset of patients with antibiotic-resistant infections, the researchers reported a significantly higher eradication rate in patients in the triple therapy group (dual 92.3% and triple 76.2%; P =.048).

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Of all the adverse events reported, 91.4% were considered minor and 8.6% moderate in severity. There were no serious adverse events reported.

A limitation of this study is that none of the H pylori strains included were resistant to amoxicillin, which is a problem in African and Mediterranean regions. This may have resulted in the high eradication rates observed. It is unclear from this study whether the dual therapy would be effective in amoxicillin-resistant infections.

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The investigators concluded that dual therapy consisting of vonoprazan and low-dose amoxicillin had acceptable eradication rates and may be a good treatment option in regions in which clarithromycin resistance is high.


Suzuki S, Gotoda T, Kusano C, et al. Seven-day vonoprazan and low-dose amoxicillin dual therapy as first-line Helicobacter pylori treatment: a multicentre randomized trial in Japan [published online January 8, 2020]. Gut. doi:10.1136/futjnl-2019-319954