Opinion Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 28, 2019; 25(16): 1907-1912
Published online Apr 28, 2019. doi: 10.3748/wjg.v25.i16.1907
Development of Helicobacter pylori treatment: How do we manage antimicrobial resistance?
Sho Suzuki, Mitsuru Esaki, Chika Kusano, Hisatomo Ikehara, Takuji Gotoda
Sho Suzuki, Mitsuru Esaki, Chika Kusano, Hisatomo Ikehara, Takuji Gotoda, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 1018309, Japan
Author contributions: All authors contributed equally to the conception and design of the study, literature review and analysis, drafting and critical revision and editing, and approval of the final version.
Conflict-of-interest statement: Gotoda T received honorarium from AstraZeneca K.K., Daiichi Sankyo Company Limited, EA Pharma Co., Ltd., and Takeda Pharmaceutical Company Limited.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Sho Suzuki, MD, PhD, Doctor, Research Associate, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo 1018309, Japan. suzuki.sho@nihon-u.ac.jp
Telephone: +81-3-32931711 Fax: +81-3-32931711
Received: February 6, 2019
Peer-review started: February 6, 2019
First decision: March 14, 2019
Revised: March 18, 2019
Accepted: March 24, 2019
Article in press: March 25, 2019
Published online: April 28, 2019
Abstract

Helicobacter pylori (H. pylori) antimicrobial resistance is an urgent, global issue. In 2017, the World Health Organization designated clarithromycin-resistant H. pylori as a high priority bacterium for antibiotic research and development. In addition to clarithromycin, resistance to metronidazole and fluoroquinolones has also increased worldwide. Recent international guidelines for management of H. pylori infection recommend bismuth or non-bismuth quadruple therapy for 14 d as a first-line treatment for H. pylori in areas of high clarithromycin and/or metronidazole resistance. Although these treatment regimens provide acceptable H. pylori eradication rates, the regimens used should not contribute to future resistance of H. pylori to antimicrobials. Moreover, these regimens can promote resistance, due to prolonged therapy with multiple antibiotics. A new strategy that can eradicate H. pylori as well as reduce the antibiotics used is required to prevent future antimicrobial resistance in H. pylori. Dual-therapy with vonoprazan and amoxicillin could be a breakthrough for H. pylori eradication in an era of growing antimicrobial resistance. This regimen may provide a satisfactory eradication rate of H. pylori and also minimize antimicrobial resistance due to single antibiotic use and the strong inhibitory effect of vonoprazan on gastric acid secretion.

Keywords: Helicobacter pylori, Antibiotic resistance, Antimicrobial resistance, Dual therapy, Vonoprazan

Core tip: The increasing antimicrobial resistance of Helicobacter pylori (H. pylori) is an urgent, global issue. Although current H. pylori treatment regimens provide acceptable eradication rates, these regimens could also be improved to optimize antibiotic usage and prevent antimicrobial resistance because these regimens use multiple antibiotic agents and have a long treatment duration. Dual therapy consisting of vonoprazan and amoxicillin may be an alternative treatment regimen for H. pylori eradication in an era of growing antimicrobial resistance and may provide sufficient H. pylori eradication rates and may help prevent future antimicrobial resistance of H. pylori.