Administration Timing of Amoxicillin Does Not Influence the Efficacy of Vonoprazan‑Amoxicillin Dual Therapy for Helicobacter pylori Eradication

Background & Aims: The effect of amoxicillin administration timing on the success of Helicobacter pylori (Hp) eradication remains uncertain. This study evaluated whether taking amoxicillin before or after meals influences the efficacy and safety of vonoprazan‑amoxicillin (VA) dual therapy. Methods: From January 2022 to June 2025, adults with Hp infection who received 14‑day VA dual therapy were included. Patients were categorized into before‑meals (n=186) or after‑meals (n=168) groups based on amoxicillin timing. Eradication was confirmed by ¹³C/ ¹⁴ C‑urea breath test. Adverse events (AEs) were recorded and factors associated with the presence of AEs were identified. Results: In total, 354 patients were included. Eradication rates were 93.5% in the before‑meals group and 89.9% in the after‑meals group (P=0.209). The incidences of AEs were low in both the groups (8.1% vs. 7.1%, P=0.744) and most AEs were mild. Underlying diseases were independently associated with a higher risk of AEs (OR=0.639, P=0.026). Conclusion: Amoxicillin administration timing does not affect the efficacy or safety of VA dual therapy for Hp eradication. This regimen achieves high eradication rates with excellent tolerability, offering dosing flexibility to improve adherence in clinical practice.