Tegoprazan-Amoxicillin Dual Therapy for Clarithromycin-Resistant Helicobacter pylori: A Feasibility Pilot Study

Tegoprazan (TPZ) has the potential to enhance Helicobacter pylori eradication. This study aimed to investigate the efficacy of TPZ-amoxicillin (TA) dual therapy against clarithromycin-resistant H. pylori strains. All H. pylori-positive patients were diagnosed by real-time polymerase chain reaction that can detect point mutations causing clarithromycin resistance. Patients infected with clarithromycin-resistant H. pylori received TA dual therapy consisting of 50 mg TPZ twice daily and high-dose amoxicillin (3 g per day) for 2 weeks. A total of 57 patients received TA dual therapy. There was a significant difference in H. pylori eradication rates between the treatment-naïve (n = 40) and treatment-experienced (n = 17) groups in the intention-to-treat and per-protocol analyses (60.0% vs. 29.4%, p = 0.035 and 70.6% vs. 31.3%, p = 0.009, respectively). Compliance with the eradication regimen was 100%, with an 8% incidence of adverse events. Multivariate analysis revealed that treatment-naïve status was a significantly independent factor associated with H. pylori eradication success (odds ratio, 8.679; p = 0.007). In conclusion, the eradication efficacy of TA dual therapy against clarithromycin-resistant H. pylori strain infections was suboptimal in treatment-naïve patients. Notably, eradication rates were significantly lower in patients with a prior history of H. pylori treatment.