In 2015, approximately 4.4 billion Helicobacter pylori infections were reported worldwide.1 Prevalence of H. pylori infections varies across countries, with more industrialised countries showing a plateau or decline in infection rates, but even in Switzerland, the country with the lowest infection rates, prevalence stands at 18.9%.1 Efforts to eradicate this disease and its associated sequelae (chronic gastritis, peptic ulcers, gastric cancer) are ongoing, but there is a lack of standardised treatments across the globe, with some treatments potentially risking gut flora dysbiosis.2-4 Furthermore, indiscriminate use of antibiotics for medical and veterinary purposes has also led to increased antimicrobial resistance in this gram-negative bacterium.3 As such, there is a pressing need for standardised treatment guidelines for H. pylori infections to minimise the associated risks.
Researchers from Nihon and Kitasato universities, Japan, reviewed current international treatment guidelines (including guidelines from the American College of Gastroenterology, and consensus reports from several countries and cities, namely Japan, Korea, China, Toronto, and Maastricht) and a network meta-analysis of H. pylori treatment outcomes to determine the current optimal treatment for H. pylori infection.3 H. pylori infection induces an ongoing state of inflammation that increases the risk of its associated sequalae.3 As such, current treatments typically aim to reduce inflammation while clearing the infection, and often include a proton pump inhibitor (PPI) and a combination of antibiotics.
Current international guidelines recommend the following H. pylori treatments3:
While these treatment regimens have exhibited successful eradication rates (~90%), even in regions with high prevalence of resistant strains, concurrent use of multiple antimicrobials still poses the risks of increased antimicrobial resistance and disturbance of natural gut microflora.3 The emergence of resistant H. pylori strains reduces treatment efficacy, therefore an ideal treatment regimen should aim to maintain eradication efficacy while reducing antibiotic consumption.3
As such, a shift to alternative regimens is required, which include3:
The vonoprazan-amoxicillin dual therapy is a simple treatment regimen with minimal disruption to natural gut microflora.3 The regimen provides favourable eradication rates and improves safety and tolerability, including reducing the risk of emergent antimicrobial resistance.3 These important findings could inform future international guidelines for the treatment of H. pylori infection in the ongoing battle against antimicrobial resistance.