This is a randomized controlled trial comparing the efficacy and safety of two vonoprazan-based regimens: high-dose dual therapy (vonoprazan plus a single antibiotic) versus triple therapy (vonoprazan plus two antibiotics) for the treatment of H. pylori infection).

Participants will be randomly assigned to receive either regimen for 14 days. The primary outcome is eradication rate , and secondary outcomes include adverse events and treatment adherence.

Study Design: This is a prospective, parallel-group, randomized controlled trial.

Setting: multi-center conducted at Damascus hospital and Iben Al-Nfees Hospital

Participants: Adult patients aged [18-70] years with confirmed [condition, e.g., H. pylori infection by urea breath test or histology]. Exclusion criteria include prior [vonoprazan use / antibiotic allergy / pregnancy / significant comorbidity].

Interventions:

Group A (High-Dose Dual Therapy): Vonoprazan [20 mg BID] + [amoxicillin, 1000 mg three times for 14 days.

Group B :levofloxacin concomitant:

levofloxacin 500 mg daily, tinidazole 500 mg, amoxicillin 1000 mg, and esomeprazole 20 mg each twice per day for 14 days.

Outcomes:

Primary: [Eradication rate / healing rate] assessed at [4-8 weeks post-treatment].

Secondary: Incidence of adverse events (mild, moderate, severe), treatment adherence (pill count or diary), and [other outcomes like symptom improvement or cost-effectiveness].

Sample Size: [N] participants per group to achieve [80-90%] power with alpha = 0.05.

Statistical Analysis: Intention-to-treat and per-protocol analyses. Categorical variables compared using chi-square or Fisher's exact test; continuous variables using t-test or Mann-Whitney U test. A p-value < 0.05 is considered statistically significant.](streamdown:incomplete-link)

Inclusion Criteria:

• Age ≥ 18 years and ≤ 80 years (adjust upper limit as needed)
• Confirmed Helicobacter pylori infection by at least one of the following: positive urea breath test, rapid urease test, histopathology, or stool antigen test
• Treatment-naïve for H. pylori (no prior eradication therapy) - OR - prior treatment failure (specify if rescue therapy)
• Willing and able to provide written informed consent
• Willing to adhere to the 14-day treatment regimen and follow-up visits
• For women of childbearing potential: negative pregnancy test and agreement to use effective contraception during the treatment period

Exclusion Criteria:

• History of allergy or hypersensitivity to vonoprazan, amoxicillin, clarithromycin, metronidazole, or any other penicillin/cephalosporin
• Previous H. pylori eradication therapy (if study is for first-line treatment)
• Active gastrointestinal bleeding or perforation
• Severe liver disease (Child-Pugh class B or C) or severe renal impairment (eGFR < 30 mL/min/1.73m²)
• Pregnancy or breastfeeding
• Concurrent use of medications with significant drug-drug interactions (e.g., warfarin, phenytoin, digoxin, atazanavir, rilpivirine)
• Malignancy or any life-threatening condition with life expectancy < 6 months
• Participation in another interventional trial within 30 days prior to enrollment
• Any condition that, in the investigator's opinion, precludes safe participation or adherence to the protocol

De-identified IPD underlying published results will be shared upon reasonable request to the corresponding author, subject to a signed data access agreement.

after ending RCT

Single-blind. Only the outcome assessor is masked to treatment assignment. Participants and care providers are not blinded due to regimen differences.