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Antimicrobial Resistance‐Stratified Efficacy of Vonoprazan, Clarithromycin, and Metronidazole Therapy for Helicobacter pylori Eradication in Penicillin‐Allergic Patients: A Single‐Arm Prospective Interventional Study

Year: 2026

Type: article

Abstract: Background: eradication regimen for patients with penicillin allergy remains a clinical challenge. Although vonoprazan-based regimens yield excellent outcomes in standard populations, we still lack sufficient evidence regarding penicillin-allergic patients. To address this gap, we investigated how a 1-week triple therapy (vonoprazan, clarithromycin [CAM], and metronidazole [MNZ]) performs in this specific cohort, particularly considering the influence of antimicrobial resistance. Methods: infection and confirmed penicillin allergy were enrolled. The treatment regimen consisted of vonoprazan (20 mg), CAM (200 mg), and MNZ (250 mg), each administered twice daily for 7 days. The primary endpoint was the eradication success rate. Secondary endpoints included safety and the association between eradication success and antimicrobial susceptibility. Results: Thirty patients completed the intervention. The overall eradication rate was 90.0% (27/30; 95% confidence interval [CI], 73.5%-97.9%) in per-protocol and intention-to-treat analyses. Adherence was high (99.7%). According to resistance profiles, eradication rates were 100% (15/15; 95% CI, 78.2%-100%) in CAM-susceptible strains, 78.6% (11/14; 95% CI, 49.2%-95.3%) in CAM-resistant strains, 92.0% (23/25; 95% CI, 74.0%-99.0%) in MNZ-susceptible strains, 75.0% (3/4; 95% CI, 19.4%-99.4%) in MNZ-resistant strains, and 50.0% (1/2) in dual-resistant strains. No serious adverse events were documented. Conclusions: eradication in patients with penicillin allergy. While the regimen achieved excellent results in CAM-susceptible strains, further optimization may be required for cases involving dual antibiotic resistance.

Source: JGH Open

DOI: 10.1002/jgh3.70487