Efficacy of a 7-day vonoprazan, sitafloxacin, and amoxicillin triple therapy as a fourth-line salvage regimen for refractory Helicobacter pylori infection
1
Issued Date
2025-12-01
Resource Type
eISSN
1471230X
Scopus ID
2-s2.0-105017386711
Journal Title
BMC Gastroenterology
Volume
25
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
BMC Gastroenterology Vol.25 No.1 (2025)
Suggested Citation
Geeratragool T., Tansirichaiya S., Kamolvit W., Atthakitmongkol T., Leartsiwawinyu W., Thaipisuttikul I., Chuenprapai P., Leelakusolvong S., Limwong C., Maneerattanaporn M. Efficacy of a 7-day vonoprazan, sitafloxacin, and amoxicillin triple therapy as a fourth-line salvage regimen for refractory Helicobacter pylori infection. BMC Gastroenterology Vol.25 No.1 (2025). doi:10.1186/s12876-025-04226-x Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/112451
Title
Efficacy of a 7-day vonoprazan, sitafloxacin, and amoxicillin triple therapy as a fourth-line salvage regimen for refractory Helicobacter pylori infection
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Abstract
Background: Treatment failure of three standard regimens for Helicobacter pylori infections has increased and represents a significant challenge. The VAS regimen, consisting of vonoprazan, amoxicillin, and sitafloxacin, represents a promising treatment option, supported by its strong acid suppression and broad-spectrum antimicrobial activity. Objectives: To evaluate the efficacy and safety of the VAS regimen as the fourth-line regimen for refractory H. pylori infection. Methods: This prospective single-arm study involved patients with H. pylori infection who had failed three standard regimens. Participants received VAS regimen; comprising vonoprazan 20 mg twice daily, amoxicillin 1000 mg twice daily, and sitafloxacin 100 mg twice daily for 7 days. Genotypic resistance was identified and CYP2C19 and CYP3A5 were studied. Eradication success was assessed using the 13C-urea breath test at 4-8 weeks post-therapy. Results: Twenty patients (mean age 64.4 ± 8.6 years) were enrolled. The eradication rate was 70.0% (95% confidence interval (CI): 45.7–88.1) in the intention-to-treat analysis and 68.42% (95% CI: 43.5–87.4) in the per-protocol analysis. Notably, genotypic resistance demonstrated 93.9% and 85.7% of levofloxacin and clarithromycin resistance respectively. Mild adverse events were reported by three patients (15%), including loose stools, nausea, and bloating. Neither antibiotic resistance nor CYP2C19 and CYP3A5 rapid metabolizer status was associated with eradication failure. Conclusion: The seven-day VAS regimen was well tolerated and demonstrated acceptably good efficacy as the fourth-line treatment for refractory H. pylori infection. The regimen offers a reasonably viable empirical rescue when lack of antibiotic susceptibility testing. Trial registration: Thai Clinical Trials Registry (Identifier: TCTR20211203002, December 3, 2021).