title: Vonoprazan improves the efficacy of Helicobacter pylori eradication therapy with a regimen consisting of clarithromycin and metronidazole in patients allergic to penicillin.
abstract: BACKGROUND
  Although all Helicobacter pylori (H. pylori)-positive patients should receive eradication therapy, the therapy is a challenge for patients allergic to penicillin. There have been a few reports on the efficacy of eradication therapy for such patients.
  
  
  OBJECTIVE
  To analyze the efficacy of vonoprazan or proton pump inhibitor (PPI)-based 7-day triple therapy in patients allergic to penicillin.
  
  
  METHODS
  A total of 88 consecutive patients allergic to penicillin who received H. pylori eradication therapy were retrospectively analyzed. Thirty-one patients had a history of failed eradication therapy. Four 7-day regimens were prescribed during the study period: clarithromycin-metronidazole-PPI (13 patients), clarithromycin-metronidazole-vonoprazan (14 patients), metronidazole-sitafloxacin-PPI (44 patients) and metronidazole-sitafloxacin-vonoprazan (17 patients). A13C-urea breath test was used for confirmation of eradication, and efficacy of eradication was evaluated by "intention-to-treat" analysis and "per-protocol" analysis.
  
  
  RESULTS
  Intention-to-treat and per-protocol eradication rates were 46.2%/54.6% for patients who received clarithromycin-metronidazole-PPI, 92.9/92.9% for patients who received clarithromycin-metronidazole-vonoprazan, 100/100% for patients who received metronidazole-sitafloxacin-PPI and 88.2/93.8% for patients who received metronidazole-sitafloxacin-vonoprazan. For first eradication, vonoprazan significantly raised the intention-to-treat efficacy of the triple therapy including clarithromycin-metronidazole (vonoprazan: 92.9%, PPI: 46.2%, P=.0128). A 7-day regimen consisting of metronidazole and sitafloxacin was effective for patients allergic to penicillin with or without past failure of eradication.
  
  
  CONCLUSIONS
  For first eradication in patients allergic to penicillin, a 7-day triple therapy consisting of clarithromycin, metronidazole and vonoprazan could be a candidate eradication regimen.
authors.affiliation: Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Shoko
authors.initials: S
authors.lastname: Ono
authors.affiliation: Department of Gastroenterology, National Hospital Organization Hakodate Hospital, Hakodate, Japan.
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Kato
authors.affiliation: Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Soichi
authors.initials: S
authors.lastname: Nakagawa
authors.affiliation: Department of Gastroenterology, National Hospital Organization Hakodate Hospital, Hakodate, Japan.
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Mabe
authors.affiliation: Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Sakamoto
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001944:Breath Tests; D002247:Carbon Isotopes / Q000032:analysis; D017291:Clarithromycin / Q000627:therapeutic use*; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D006967:Hypersensitivity / Q000150:complications; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use*; D008875:Middle Aged; D011758:Pyrroles / Q000627:therapeutic use*; D012189:Retrospective Studies; D013449:Sulfonamides / Q000627:therapeutic use*; D016896:Treatment Outcome; D014508:Urea / Q000032:analysis
chemical_list: C552956:1-(5-(2-fluorophenyl)-1-(pyridin-3-ylsulfonyl)-1H-pyrrol-3-yl)-N-methylmethanamine; D000900:Anti-Bacterial Agents; D002247:Carbon Isotopes; D011758:Pyrroles; D013449:Sulfonamides; D008795:Metronidazole; D014508:Urea; D017291:Clarithromycin
keywords: 
  Helicobacter pylori
  ; eradication therapy; penicillin allergy; vonoprazan