Influence of clarithromycin on the bactericidal effect of amoxicillin in patients infected with clarithromycin-resistant strains of H. pylori

We read the manuscript written by Suzuki et al 1 with interest. They reported that the eradication rate of Helicobacter pylori attained by the dual therapy with vonoprazan and amoxicillin (VA-Dual) was almost the same as that attained by the triple therapy with vonoprazan, amoxicillin and clarithromycin (VAC-Triple), as previously reported by us.2 The most interesting point in this paper was that the VA-Dual therapy was superior to the VAC-Triple therapy in eradicating the clarithromycin-resistant strains of H. pylori . In this regard, the authors consider the possibilities of a type I error, the difference in the proportion of amoxicillin-resistant strains, and the excessive inhibition of gastric acid secretion …