Vonoprazan-amoxicillin dual therapy for Helicobacter pylori eradication: Clinical, pharmacogenetic, and microbiome perspectives

Table 2 Key factors affecting vonoprazan-amoxicillin dual therapy efficacy

Factor1	Sub-items/examples	Potential impact on vonoprazan-amoxicillin efficacy	Ref.
Population/geographic differences	Region, age, sex, dietary habits, healthcare access	Variation in eradication rates across countries, age groups, and healthcare systems	[6,21,46,58]
Host pharmacogenetics	CYP2C19/CYP3A4/CYP3A5 polymorphisms, age-related metabolism	Altered acid suppression, drug pharmacokinetics, variability in eradication success	[10,11,59,60,70]
Gut microbiome impact	Microbial diversity, SCFAs, dysbiosis, probiotic adjuncts	Short- and long-term ecological changes, potential resistome alteration	[23-25,36,56,61]
Antimicrobial resistance	Amoxicillin low but rising clarithromycin/metronidazole resistance; special populations (penicillin allergy, immunocompromised)	Treatment failure, need for alternative regimens, risk of resistance development	[9,26,30,38,40,43,54,55,60,61]
Treatment strategy optimization	Dose, duration, timing relative to meals	Suboptimal dose/duration reduces efficacy; careful selection required for 10-day vs 14-day regimens	[48,49,51,52,63,65-67]

¹Factors include population/geographic differences, host pharmacogenetics, microbiome impact, antimicrobial resistance, and treatment strategy optimization. The table summarizes sub-items, their potential impact on eradication success, and key references supporting each factor.

SCFA: Short-chain fatty acid.