Tag Archives: tetracycline

Vonoprazan-Tetracycline: Effective Dual Rescue Regimen for H Pylori

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W Gao et al. Gastroenterol 2026; 170: 1473-1483. Open Access! Vonoprazan-Tetracycline Dual Regimen as Rescue Therapy for Helicobacter pylori Infection: Randomized Controlled Trial

Methods: In this prospective, open-label, randomized controlled trial(n=350), H pylori–positive adults with at least 1 prior eradication failure were allocated 1:1 to VT dual therapy (vonoprazan [20 mg, twice a day] and tetracycline [500 mg, 3 times a day]), or bismuth quadruple therapy (BQT; lansoprazole [30 mg, twice a day], colloidal bismuth [150 mg, 3 times a day], tetracycline [500 mg, 3 times a day], and metronidazole [400 mg, 3 times a day]) for 14 days.

Key findings:

Discussion:

  • “Potent acid suppression broadens the applicability of dual therapy, allowing a single sensitive antibiotic to achieve reliable eradication when gastric pH is maintained at ≥6 with potassium-competitive acid blockers.13–15“
  • “Antibiotic resistance is a major obstacle to the successful eradication of H pylori, particularly in rescue treatment. Surveillance data from the Asia-Pacific region (1990–2022) have shown persistently high resistance rates to metronidazole (52%), levofloxacin (26%), and clarithromycin (22%), whereas resistance to tetracycline and amoxicillin has remained low, both at ∼4%.17“
  • “Although high-dose amoxicillin dual therapy has been well studied and incorporated into guidelines for first-line treatment, the clinical potential of tetracycline-based regimens deserves similar attention.19,20“

Limitations: This was an open-label trial from a single center and did not include antibiotic resistance testing, which may limit generalizability to other regions or clinical settings.

My take (borrowed from authors): Vonoprazan combined with tetracycline is a simplified, penicillin-free rescue regimen, and may offer a practical option for the rescue treatment of H pylori infection. Its eradication rate was comparable to that of traditional tetracycline-metronidazole–based bismuth quadruple therapy, and was associated with fewer adverse events and better adherence. 

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High Rates of Helicobacter Pylori Resistance

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While the development of antibacterial resistance has broad implications, in gastroenterology patients specific problems have emerged with Helicobacter pylori (H pylori) and this has led to changes in first-line therapy( ).  More data on the treatment resistant H pylori has been published (JPGN 2013; 56: 645-48).

77 consecutive strains of H pylori  from Brazilian children and adolescents were isolated from gastric biopsies and analyzed; this study took place between 2008-2009 and the mean age was 11.1 years.  In 71 strains, there were no previous attempts at eradication.

Results:

  • 40% of strains were resistant to metronidazole
  • 19.5% of strains were resistant to clarithromycin
  • 10.4% of strains were resistant to amoxicillin
  • All strains were susceptible to furazolidone and tetracycline
  • 14/77 (18.2%) patients had multiple resistances

Take-home point: Resistance to antibiotics is altering our approach to H pylori therapy.  Antibiotic susceptibility testing may be needed to improve antibiotic selection and eradication rates.

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