A real‐world exploratory study on the feasibility of vonoprazan and tetracycline dual therapy for the treatment of Helicobacter pylori infection in special populations with penicillin allergy or failed in previous amoxicillin‐containing therapies

• DOI: 10.1111/hel.12947
• Publication Date: 2023-01-18T05:28:16Z
• Authors: Wen Gao; Ying Xu; Jianxiang Liu; Xiaolei Wang; Xinhong Dong; Guigen Teng; Binbin Liu; Jinpei Dong; Chaoyi Ge; Hui Ye; Xuezhi Zhang; Hong Cheng
• Keywords: Penicillin allergy; Physiology; Penicillins; Microbiology; Helicobacter Infections; 03 medical and health sciences; 0302 clinical medicine; Antibiotics; Clarithromycin; Health Sciences; Hypersensitivity; Humans; Internal medicine; Biology; Helicobacter pylori; Dual (grammatical number); Amoxicillin; Proton Pump Inhibitors; Tetracycline; Penicillin; Asthma; 3. Good health; Anti-Bacterial Agents; Treatment; Treatment Outcome; Helicobacter pylori Infection and Gastric Cancer; Literature; FOS: Biological sciences; Feasibility Studies; Medicine; Drug Therapy, Combination; Surgery; Art; Diagnosis and Management of Eosinophilic Esophagitis

AbstractBackgroundThe treatment of Helicobacter pylori (H. pylori) infection is a challenge for those who cannot use amoxicillin.ObjectiveTo evaluate the eradication rate and adverse effects of vonoprazan and tetracycline dual therapy as first‐line and rescue treatment regimens used in special populations with penicillin allergy or failed in previous amoxicillin‐containing therapies.DesignPatients enrolled were those who were H. pylori‐positive with selected conditions: (1) allergic to penicillin, either naïve to treatment or had failed before; or (2) failed in previous amoxicillin‐containing therapies. All enrolled patients accepted 14‐day vonoprazan and tetracycline dual therapy (VT dual therapy) as follows: vonoprazan (20 mg b.i.d.) and tetracycline (500 mg t.i.d. [body weight < 70 kg] or 500 mg q.i.d. [body weight ≥ 70 kg]). H. pylori status was evaluated by 13C‐urease breath test 6 weeks after treatment. All adverse effects were recorded. Some patients underwent bacterial culture and antibiotic susceptibility testing.ResultsA total of 62 patients were enrolled; 18 of them received VT dual therapy as first‐line treatment, 44 patients received VT dual therapy as rescue treatment. Overall, 58 of 62 patients achieved successful eradication (93.5%), while all involved (100%,18/18) succeeded in the first‐line treatment group and 40 cases (90.9%, 40/44) succeeded in the rescue treatment group. Sixty‐one (61/62, 98.4%) patients completed the whole course of treatment. Adverse events occurred in 6 patients (6/62, 9.7%), while one patient quit because of skin rash. All adverse effects were mild and relieved spontaneously after H. pylori treatment. Five patients achieved successful H. pylori culture, and all strains isolated were sensitive to tetracycline.ConclusionsFor the treatment of H. pylori infection in special populations with penicillin allergy or failed in previous amoxicillin‐containing therapies, a 14‐day vonoprazan and tetracycline dual therapy was effective and safe as first‐line and rescue treatment in our study. Further study is warranted to verify its efficacy, especially for those who cannot use amoxicillin.