High- vs. Low-Dose Amoxicillin Combined with Vonoprazan for H. pylori Eradication
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Reviewed by Dat Tien Nguyen, B.A, ScM.
Translated by Nhi Phuong Quynh Le, B.A |
Posted on February 28th, 2025
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The combination of amoxicillin and vonoprazan has proven effective for treating and curing Helicobacter pylori infections. However, the optimal antibiotic dose remains uncertain, which is critical given its potential impact on gut microbiota. With rising concerns about antibiotic resistance, it is important to identify a dose that both eradicates the bacteria and minimizes the development of resistant strains. A study funded by the National Natural Science Foundation of China and recently published in The Lancet investigated the optimal dose of amoxicillin and vonoprazan in terms of efficacy, gut microbiota, and resistance.
The open-label clinical trial was conducted in China and included 504 patients diagnosed with Helicobacter pylori infection, confirmed by a positive carbon-13 urea breath test. Endoscopic examinations revealed that over 90% had gastritis, and more than 5% had developed peptic ulcers. H. pylori was successfully isolated in about 85% of participants; antibiogram testing showed that all isolates were fully susceptible to amoxicillin, tetracycline, and furazolidone, while resistance rates to levofloxacin, clarithromycin, and metronidazole were 27%, 28%, and 74%, respectively. Moreover, 10–20% of isolates displayed resistance to two antibiotics, and 9% were resistant to all three.
Participants were treated with 20 mg of vonoprazan twice daily, alongside either a high or low dose of amoxicillin. The high-dose regimen consisted of three 1 g doses of amoxicillin per day, while the low-dose schedule involved two 1 g doses per day. After two weeks of treatment, the researchers found that both regimens—with total daily amoxicillin doses of 2 g or 3 g—were equally effective at eradicating Helicobacter pylori, achieving eradication rates of 85–90%. Metagenomic analyses of stool samples collected between the eighth and tenth week showed that both amoxicillin concentrations led to a similar reduction in gut microbial diversity, and there was no significant difference in the prevalence of beta-lactam resistance genes between the groups.
The open-label clinical trial was conducted in China and included 504 patients diagnosed with Helicobacter pylori infection, confirmed by a positive carbon-13 urea breath test. Endoscopic examinations revealed that over 90% had gastritis, and more than 5% had developed peptic ulcers. H. pylori was successfully isolated in about 85% of participants; antibiogram testing showed that all isolates were fully susceptible to amoxicillin, tetracycline, and furazolidone, while resistance rates to levofloxacin, clarithromycin, and metronidazole were 27%, 28%, and 74%, respectively. Moreover, 10–20% of isolates displayed resistance to two antibiotics, and 9% were resistant to all three.
Participants were treated with 20 mg of vonoprazan twice daily, alongside either a high or low dose of amoxicillin. The high-dose regimen consisted of three 1 g doses of amoxicillin per day, while the low-dose schedule involved two 1 g doses per day. After two weeks of treatment, the researchers found that both regimens—with total daily amoxicillin doses of 2 g or 3 g—were equally effective at eradicating Helicobacter pylori, achieving eradication rates of 85–90%. Metagenomic analyses of stool samples collected between the eighth and tenth week showed that both amoxicillin concentrations led to a similar reduction in gut microbial diversity, and there was no significant difference in the prevalence of beta-lactam resistance genes between the groups.