Antibiotic resistance is a serious concern and therefore affects our decision to choose a suitable eradication regemen for H. pylori infection. Indeed we are facing increasing prevalences of H. pylori strains around the world, which enforces us to use more complicated regimens with increased number of antibiotics such as concomittant therapy or bismuth quadruple therapy for a prolonged period as compared with the conventional triple therapy. In Japan, however, the conventional triple therapy is still recommended as consecutive use of the two conventional triple therapies are quite effective and can reduce the amount of antibiotic use. In addition, vonoprazan-based triple therapy is also recommended and now this regimen plays the major role in eradication therapy in Japan.
Furthermore, vonoprazan-AMPC dual therapy exhibited non-inferiority to vonoprazan-triple therapy, which may pave the way to simplify the eradication therapy as AMPC resistance is rare in many parts of the world. Regarding the purpose of reducing antibiotic use, more efforts should be paid for developing effective vaccines againt H. pylori. Improvement of sanitation is another aspect of reducing H. pylori, which also will contribute to reduce waterborne infections enabling further cut down on antibiotic use.