Published online Apr 28, 2019. doi: 10.3748/wjg.v25.i16.1907
Peer-review started: February 6, 2019
First decision: March 14, 2019
Revised: March 18, 2019
Accepted: March 24, 2019
Article in press: March 25, 2019
Published online: April 28, 2019
Helicobacter pylori (H. pylori) antimicrobial resistance is an urgent, global issue. In 2017, the World Health Organization designated clarithromycin-resistant H. pylori as a high priority bacterium for antibiotic research and development. In addition to clarithromycin, resistance to metronidazole and fluoroquinolones has also increased worldwide. Recent international guidelines for management of H. pylori infection recommend bismuth or non-bismuth quadruple therapy for 14 d as a first-line treatment for H. pylori in areas of high clarithromycin and/or metronidazole resistance. Although these treatment regimens provide acceptable H. pylori eradication rates, the regimens used should not contribute to future resistance of H. pylori to antimicrobials. Moreover, these regimens can promote resistance, due to prolonged therapy with multiple antibiotics. A new strategy that can eradicate H. pylori as well as reduce the antibiotics used is required to prevent future antimicrobial resistance in H. pylori. Dual-therapy with vonoprazan and amoxicillin could be a breakthrough for H. pylori eradication in an era of growing antimicrobial resistance. This regimen may provide a satisfactory eradication rate of H. pylori and also minimize antimicrobial resistance due to single antibiotic use and the strong inhibitory effect of vonoprazan on gastric acid secretion.
Core tip: The increasing antimicrobial resistance of Helicobacter pylori (H. pylori) is an urgent, global issue. Although current H. pylori treatment regimens provide acceptable eradication rates, these regimens could also be improved to optimize antibiotic usage and prevent antimicrobial resistance because these regimens use multiple antibiotic agents and have a long treatment duration. Dual therapy consisting of vonoprazan and amoxicillin may be an alternative treatment regimen for H. pylori eradication in an era of growing antimicrobial resistance and may provide sufficient H. pylori eradication rates and may help prevent future antimicrobial resistance of H. pylori.