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Helicobacter pylori first-line and rescue treatments in patients allergic to penicillin: Experience from the European Registry on H pylori management (Hp-EuReg)

OP. Nyssen, Á. Pérez-Aisa, B. Tepes, L. Rodrigo-Sáez, PM. Romero, A. Lucendo, M. Castro-Fernández, P. Phull, J. Barrio, L. Bujanda, J. Ortuño, M. Areia, N. Brglez Jurecic, JM. Huguet, N. Alcaide, I. Voynovan, J. María Botargues Bote, I. Modolell,...

. 2020 ; 25 (3) : e12686. [pub] 20200316

Jazyk angličtina Země Velká Británie

Typ dokumentu časopisecké články

Perzistentní odkaz   https://www.medvik.cz/link/bmc20028129

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.

Aberdeen Royal Infirmary Aberdeen UK

Centro Hospitalar do Porto Institute of Biomedical Sciences Abel Salazar University of Porto and CINTESIS University of Porto Porto Portugal

Consorci Sanitari Terrassa Terrassa Spain

Department of Gastroenterology and Internal Medicine and Department of Surgery University Hospital Brno Faculty of Medicine Masaryk University Brno Czech Republic

Department of Gastroenterology Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas Donosti Spain

Department of Gastroenterology Hepatology and Infectious Diseases Otto von Guericke University Hospital Magdeburg Germany

Department of Gastroenterology Hepatology and Nutrition CHU Charleroi Charleroi Belgium

Department of Gastroenterology Lithuanian University of Health Sciences Kaunas Lithuania

Department of Gastroenterology Rabin Medical Center Tel Aviv University Petach Tikva Israel

Department of Gastroenterology School of Medicine University Hospital of Split University of Split Split Croatia

Department of Medical Microbiology Medical University of Sofia Sofia Bulgaria

Department of Medicine Zealand University Hospital Copenhagen University Copenhagen Denmark

Department of Pancreatobiliary and Upper GI Diseases Moscow Clinical Scientific Center A 1 Yevdokimov Moscow State University of Medicine and Dentistry Moscow Russia

Diagnostic Centre Bled Bled Slovenia

Digestive Unit Agencia Sanitaria Costa del Sol Marbella Spain Red de Investigación en Servicios de Salud en Enfermedades Crónicas Málaga Spain

Faculty of Health Sciences Trinity College Dublin Dublin Ireland

Faculty of Medicine Institute of Clinical and Preventive Medicine University of Latvia Riga Latvia

Gastroenterology and Hepatology Erasmus MC University Rotterdam The Netherlands

Gastroenterology Unit AM DC Rogaska Rogaska Slatina Slovenia

Gastroenterology Unit Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas Hospital Universitario de La Princesa Universidad Autónoma de Madrid Madrid Spain

Gastroenterology Unit Ferencváros Policlinic Budapest Hungary

Gastroenterology Unit Henry Dunant Hospital Athens Greece

Gastroenterology Unit Hospital Universitario Central de Asturias Oviedo Spain

Gastroenterology Unit Medical Centre for Postgraduate Education Warsaw Poland

Gastroenterology Unit Timisoara Hospital Timisoara Romania

Gastroenterology Unit University of Leeds Leeds UK

Gastronterology Area Fondazione Policlinico Universitario A Gemelli Rome Italy

Hacettepe University Faculty of Medicine Ankara Turkey

HM Sanchinarro Madrid Spain

Hospital Clínico Universitario Lozano Blesa Zaragoza Spain

Hospital Clínico Universitario Valladolid Valladolid Spain

Hospital de San Jorge Huesca Spain

Hospital de Tomelloso Sevilla Spain

Hospital de Valme Sevilla Spain

Hospital General Universitario de Valencia Valencia Spain

Hospital Quiron Marbella Marbella Spain

Hospital Río Hortega Valladolid Spain

Hospital San Pedro de Alcántara Cáceres Spain

Hospital Universitari de Bellvitge L'Hospitalet de Llobregat Spain

Hospital Universitari i Politècnic La Fe Valencia Spain

Internal Diseases Department No 1 National Medical University named after O O Bogomolets Kyiv Ukraine

Laboratoire de Bactériologie Hôpital Pellegrin Bordeaux Cedex France

Medical Department Central Hospital Ostfold Fredrikstad Norway

Medical Department Clinical Center of Serbia Clinic for Gastroenterology and Hepatology University of Belgrade Belgrade Serbia

Portuguese Oncology Institute Coimbra Portugal

Citace poskytuje Crossref.org

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