{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:09:12Z","timestamp":1790611752653,"version":"4.1.0"},"reference-count":42,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,9,21]],"date-time":"2020-09-21T00:00:00Z","timestamp":1600646400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["DK56338"],"award-info":[{"award-number":["DK56338"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Amoxicillin and proton pump inhibitor dual<jats:italic>Helicobacter pylori<\/jats:italic>therapy has proved not to be reliably highly effective primarily because of traditional proton pump inhibitors' inability to maintain a high intragastric pH. Clarithromycin and proton pump inhibitor<jats:italic>H.\u00a0pylori<\/jats:italic>dual therapy failed in part because clarithromycin resistance emerged during therapy causing treatment failures. The combination of amoxicillin, clarithromycin, and proton pump inhibitor was subsequently undermined by increasing clarithromycin resistance. Although vonoprazan appeared to restore the effectiveness of triple therapy, the improvement was almost entirely to improved effectiveness of amoxicillin dual therapy component and resulted in the majority (&gt;85% currently in Japan) of those receiving vonoprazan\u2013amoxicillin plus a second antibiotic (e.g. clarithromycin, metronidazole, fluoroquinolone, or rifabutin) receiving no benefit from the second antibiotic. The results in somewhere between 2800 and 5600\u00a0kg of unnecessary clarithromycin per one million<jats:italic>H.\u00a0pylori<\/jats:italic>treatment courses per year in Japan. The only contribution of the second antibiotic is to increase global antimicrobial resistance. There are now sufficient data to prove that optimized vonoprazan\u2013amoxicillin dual therapy can reliably achieve cure rates\u00a0\u226595%. This manuscript discusses use of the principles of antimicrobial stewardship to develop potassium\u2010competitive acid blocker\u2010containing<jats:italic>H.\u00a0pylori<\/jats:italic>therapies that will reliably achieve high<jats:italic>H.\u00a0pylori<\/jats:italic>cure rates with minimal or no use of excess antibiotics. Such therapies are urgently needed so that use of vonoprazan triple therapies can be curtailed while also improving overall<jats:italic>H.\u00a0pylori<\/jats:italic>cure rates.<\/jats:p>","DOI":"10.1111\/jgh.15252","type":"journal-article","created":{"date-parts":[[2020,9,21]],"date-time":"2020-09-21T19:17:22Z","timestamp":1600715842000},"page":"1159-1163","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":64,"title":["Vonoprazan\u2010containing<i>Helicobacter pylori<\/i>triple therapies contribution to global antimicrobial resistance"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6908-8317","authenticated-orcid":false,"given":"David Y","family":"Graham","sequence":"first","affiliation":[{"name":"Department of Medicine Michael E. 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