{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:38:05Z","timestamp":1791999485374,"version":"4.4.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Bismuth-containing quadruple therapy, the standard\n                      <jats:italic>Helicobacter pylori<\/jats:italic>\n                      (\n                      <jats:italic>H. pylori<\/jats:italic>\n                      ) eradication regimen, is limited by adverse events and rising resistance. Vonoprazan-amoxicillin dual therapy offers simplicity but has mostly been tested using high-dose amoxicillin. Data on doxycycline in this context are scarce, and vonoprazan-doxycycline dual therapy remains unexplored.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A total of 579\n                      <jats:italic>H. pylori<\/jats:italic>\n                      -positive patients were enrolled and randomly assigned in a 1:1:1 ratio to one of three 14-day treatment groups: the VBQ group (vonoprazan 20 mg, amoxicillin 1000 mg, doxycycline 100 mg, and colloidal bismuth pectin 300 mg, all twice daily); the VA group (vonoprazan 20 mg and amoxicillin 1000 mg, twice daily); and the VD group (vonoprazan 20 mg and doxycycline 100 mg, twice daily). A\n                      <jats:sup>13<\/jats:sup>\n                      C-urea breath test (UBT) was performed at least four weeks after treatment completion.\n                      <jats:italic>H. pylori<\/jats:italic>\n                      eradication rates, the incidence of adverse events during treatment, and medication adherence were compared among the three groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the intention-to-treat (ITT), modified intention-to-treat (mITT), and per-protocol (PP) analyses, the VA regimen demonstrated non-inferiority to the VBQ regimen. The VD regimen did not meet the non-inferiority criterion in the ITT analysis (79.3% vs. 83.4%, P\u00a0=\u00a00.070 for non-inferiority), but it demonstrated non-inferiority to the VBQ regimen in both the mITT (87.4% vs. 90.4%, P\u00a0=\u00a00.018) and PP (87.7% vs. 90.1%, P\u00a0=\u00a00.012) analyses. The overall incidence of adverse events was not significantly different between the VBQ and VA groups (P\u00a0=\u00a00.313), but it was significantly lower in the VD group compared to the VBQ group (P\u00a0=\u00a00.002). No statistically significant differences in medication adherence were observed between the VBQ group and either the VA (P\u00a0=\u00a00.381) or VD (P\u00a0=\u00a00.269) group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Vonoprazan-low-dose amoxicillin dual therapy is a safe and simple alternative to bismuth containing quadruple therapy. Vonoprazan-doxycycline dual therapy demonstrates acceptable efficacy and may be considered for patients allergic to amoxicillin. Both align with antimicrobial stewardship principles of regimen simplification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1881347","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T05:40:01Z","timestamp":1783057201000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Vonoprazan-based dual therapy with amoxicillin or doxycycline versus bismuth-containing quadruple therapy for Helicobacter pylori eradication: a prospective, multicenter, open-label, randomized controlled trial"],"prefix":"10.3389","volume":"16","author":[{"given":"Haocheng","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Nanjing First Hospital, Nanjing Medical University","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Jinhu County People\u2019s Hospital","place":["Huaian, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihong","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The Second Affiliated Hospital, Xuzhou Medical University","place":["Xuzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangxia","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Xuzhou First People\u2019s Hospital","place":["Xuzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weixuan","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Huai\u2019an Hospital Affiliated to Yangzhou University (The Fifth People\u2019s Hospital of Huai\u2019an)","place":["Huai\u2019an, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunming","family":"Fei","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The People\u2019s Hospital of Luhe","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoli","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The Fourth Affiliated Hospital of Nanjing Medical University","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhimei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Lianyungang Clinical College of Nanjing Medical University","place":["Lianyungang, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiujuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Nanjing First Hospital, Nanjing Medical University","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiahuan","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Nanjing First Hospital, Nanjing Medical University","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenyu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Nanjing First Hospital, Nanjing Medical University","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2022.111064","article-title":"Antibiotic adverse effects in pediatric acute rhinosinusitis: Systematic review and meta-analysis","volume":"156","author":"Axiotakis","year":"2022","journal-title":"Int. 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