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

Tegoprazan (TPZ) has the potential to enhance <i>Helicobacter pylori</i> eradication. This study aimed to investigate the efficacy of TPZ-amoxicillin (TA) dual therapy against clarithromycin-resistant <i>H. pylori</i> strains. All <i>H. pylori</i>-positive patients were diagnosed by real-time polymerase chain reaction that can detect point mutations causing clarithromycin resistance. Patients infected with clarithromycin-resistant <i>H. pylori</i> 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 <i>H. pylori</i> eradication rates between the treatment-naïve (<i>n</i> = 40) and treatment-experienced (<i>n</i> = 17) groups in the intention-to-treat and per-protocol analyses (60.0% vs. 29.4%, <i>p</i> = 0.035 and 70.6% vs. 31.3%, <i>p</i> = 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 <i>H. pylori</i> eradication success (odds ratio, 8.679; <i>p</i> = 0.007). In conclusion, the eradication efficacy of TA dual therapy against clarithromycin-resistant <i>H. pylori</i> strain infections was suboptimal in treatment-naïve patients. Notably, eradication rates were significantly lower in patients with a prior history of <i>H. pylori</i> treatment.