Helicobacter pylori first‐line and rescue treatments in patients allergic to penicillin: Experience from the European Registry on H pylori management (Hp‐EuReg). Issue 3 (16th March 2020)

• Record Type: Journal Article
• Authors: Nyssen, Olga P.; Pérez‐Aisa, Ángeles; Tepes, Bojan; Rodrigo‐Sáez, Luis; Romero, Pilar M.; Lucendo, Alfredo; Castro‐Fernández, Manuel; Phull, Perminder; Barrio, Jesús; Bujanda, Luis; Ortuño, Juan; Areia, Miguel; Brglez Jurecic, Natasa; Huguet, José María; Alcaide, Noelia; Voynovan, Irina; María Botargues Bote, José; Modolell, Inés; Pérez Lasala, Jorge; Ariño, Inés; Jonaitis, Laimas; Dominguez‐Cajal, Manuel; Buzas, György; Lerang, Frode; Perona, Monica; Bordin, Dmitry; Axon, Toni; Gasbarrini, Antonio; Marcos Pinto, Ricardo; Niv, Yaron; Kupcinskas, Limas; Tonkic, Ante; Leja, Marcis; Rokkas, Theodore; Boyanova, Lyudmila; Shvets, Oleg; Venerito, Marino; Bytzer, Peter; Goldis, Adrian; Simsek, Ilkay; Lamy, Vincent; Przytulski, Krzysztof; Kunovský, Lumír; Capelle, Lisette; Milosavljevic, Tomica; Caldas, María; Garre, Ana; Mégraud, Francis; O'Morain, Colm; Gisbert, Javier P.;
• Other Names: Hinojosa Jennifer investigator.; Fernández Nuria investigator.; Molina Infante Javier investigator.; Alonso Galán Horacio investigator.; Di Maira Tommaso investigator.; Alves Susana Isabel investigator.; Saraiva Sandra investigator.; Elvas Luis investigator.; Brito Daniel investigator.; Teresa Cadime Ana investigator.; Lampic Polona investigator.; Gruncic Aleksander investigator.; Leban Vid investigator.; Ferrer Luis investigator.; Fernandez Salazar Luis investigator.; Lanas Angel investigator.; Kristensen Vendel investigator.; Brackmann Stephan investigator.; Delchier Jean Charles investigator.; Anton Charo investigator.; Gomez Rodriguez Blas Jose investigator.; Pellicano Rinaldo investigator.; Boltin Doron investigator.
• Is Part Of: Helicobacter. Volume 25:Issue 3(2020)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2020-03-16
• Subjects: allergic -- allergy -- bismuth -- clarithromycin -- Helicobacter pylori -- levofloxacin -- penicillin; Helicobacter -- Periodicals; Helicobacter infections -- Periodicals; Stomach -- Diseases -- Periodicals; 616.3301405
• DOI: 10.1111/hel.12686
• Languages: English
• ISSNs: 1083-4389

Abstract

Abstract: Background: Experience in Helicobacter pylori eradication treatment of patients allergic to penicillin is very scarce. A triple combination with a PPI, clarithromycin (C), and metronidazole (M) is often prescribed as the first option, although more recently the use of a quadruple therapy with PPI, bismuth (B), tetracycline (T), and M has been recommended. Aim: To evaluate the efficacy and safety of first‐line and rescue treatments in patients allergic to penicillin in the "European Registry of H pylori management" (Hp‐EuReg). Methods: A systematic prospective registry of the clinical practice of European gastroenterologists (27 countries, 300 investigators) on the management of H pylori infection. An e‐CRF was created on AEG‐REDCap. Patients with penicillin allergy were analyzed until June 2019. Results: One‐thousand eighty‐four patients allergic to penicillin were analyzed. The most frequently prescribed first‐line treatments were as follows: PPI + C + M (n = 285) and PPI + B + T + M (classic or Pylera ® ; n = 250). In first line, the efficacy of PPI + C + M was 69%, while PPI + B + T + M reached 91% ( P < .001). In second line, after the failure of PPI + C + M, two rescue options showed similar efficacy: PPI + B + T + M (78%) and PPI + C + levofloxacin (L) (71%) ( P > .05). In third line, after the failure of PPI + C + M and PPI + C + L, PPI + B + T + M was successful in 75% of cases. Conclusion: In patients allergic to penicillin, a triple combination with PPI + C + M should not be generally recommended as a first‐line treatment, while a quadruple regimen with PPI + B + T + M seems to be a better option. As a rescue treatment, this quadruple regimen (if not previously prescribed) or a triple regimen with PPI + C + L could be used but achieved suboptimal (<80%) results.