Vonoprazan and PPIs in H. pylori eradication: Insights into clarithromycin resistance

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Created On: 26/06/2025

This systematic review and meta-analysis explored the usefulness of vonoprazan (gastric acid suppressant) in eradicating both clarithromycin-susceptible and clarithromycin-resistant H. pylori strains.

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Key take away

Vonoprazan-based therapy shows comparable efficacy to PPI therapy for clarithromycin-susceptible H. pylori, but is more effective for resistant strains.

Background

Method

Databases like PubMed, EMBASE, Web of Science, and the Cochrane Library were systematically searched for studies comparing vonoprazan-based triple therapy with standard proton-pump inhibitor (PPI)-based regimens. Only studies that assessed clarithromycin susceptibility were included to provide a clear picture of treatment efficacy across different resistance profiles.

Result

In total, 5 studies encompassing 1,599 patients provided relevant data. Among those with clarithromycin-susceptible H. pylori, eradication rates were similar between vonoprazan-based and conventional PPI-based therapies in both randomized controlled trials (RCTs) and nonrandomized controlled trials (NRCTs). However, in those infected with clarithromycin-resistant strains, vonoprazan-based therapy exhibited markedly higher eradication rates than PPI-based therapy in both RCTs and NRCTs (Table 1).

Conclusion

Vonoprazan-based regimens demonstrated comparable efficacy to conventional PPI-based therapies in eliminating H. pylori strains sensitive to clarithromycin. However, vonoprazan clearly outperformed PPIs when tackling clarithromycin-resistant infections. Notably, the frequent use of clarithromycin may be unwarranted, as vonoprazan combined with amoxicillin alone achieved eradication in roughly 80% of cases.

Source:

Helicobacter

Link:

https://pubmed.ncbi.nlm.nih.gov/29873436/

Article:

Systematic review with meta-analysis: Vonoprazan, a potent acid blocker, is superior to proton-pump inhibitors for eradication of clarithromycin-resistant strains of Helicobacter pylori