Treatment considerations in Helicobacter pylori management.

Dual therapy with vonoprazan and amoxicillin is as effective as triple therapy with vonoprazan, amoxicillin and clarithromycin for eradication of Helicobacter pylori. These include the need to collect antibiotic sensitivity profiles (if possible) before treatment, and to prescribe tailored therapy (precise treatment), while understanding that the current standard of using first-line therapies (empiric treatment) is more practical with real-life clinical scenarios. PPI-amoxicillin dual therapy four times daily is superior to guidelines recommended regimens in the Helicobacter pylori eradication therapy within Asia: A systematic review and meta-analysis. In an era with rising antibiotic resistance to clarithromycin and metronidazole, rifabutin-containing triple therapy should be considered when patients fail triple therapy or BQT, an approach recommended by most treatment guidelines since the prevalence of rifabutin resistance is still very low or non-existent.3-5 In the U.S., a low-dose (50mg TID) rifabutin-containing triple therapy was recently approved by the Food and Drug Administration (FDA) with superior efficacy vs HDDT30 but its use has not been included in most practice guidelines. [Extracted from the article]