Development of treatment: How do we manage antimicrobial resistance?

() antimicrobial resistance is an urgent, global issue. In 2017, the World Health Organization designated clarithromycin-resistant as a high priority bacterium for antibiotic research and development. In addition to clarithromycin, resistance to metronidazole and fluoroquinolones has also increased worldwide. Recent international guidelines for management of infection recommend bismuth or non-bismuth quadruple therapy for 14 d as a first-line treatment for in areas of high clarithromycin and/or metronidazole resistance. Although these treatment regimens provide acceptable eradication rates, the regimens used should not contribute to future resistance of to antimicrobials. Moreover, these regimens can promote resistance, due to prolonged therapy with multiple antibiotics. A new strategy that can eradicate as well as reduce the antibiotics used is required to prevent future antimicrobial resistance in . Dual-therapy with vonoprazan and amoxicillin could be a breakthrough for eradication in an era of growing antimicrobial resistance. This regimen may provide a satisfactory eradication rate of and also minimize antimicrobial resistance due to single antibiotic use and the strong inhibitory effect of vonoprazan on gastric acid secretion.