engleski

Empirical rescue treatment of Helicobacter pylori infection in third and subsequent lines: 8-year experience in 2144 patients from the European Registry on H. pylori management (Hp-EuReg)

Objective: To evaluate the use, effectiveness and safety of Helicobacter pylori empirical rescue therapy in third and subsequent treatment lines in Europe. Design International, prospective, non- interventional registry of the clinical practice of European gastroenterologists. Data were collected and quality reviewed until October 2021 at Asociacion Espanola de Gastroenterologia- Research Electronic Data Capture. All cases with three or more empirical eradication attempts were assessed for effectiveness by modified intention- to-treat and per-protocol analysis. Results: Overall, 2144 treatments were included: 1519, 439, 145 and 41 cases from third, fourth, fifth and sixth treatment lines, respectively. Sixty different therapies were used ; the 15 most frequently prescribed encompassed > 90% of cases. Overall effectiveness remained < 90% in all therapies. Optimised treatments achieved a higher eradication rate than non-optimised (78% vs 67%, p < 0.0001). From 2017 to 2021, only 44% of treatments other than 10-day single-capsule therapy used high proton-pump inhibitor doses and lasted & GE ; 14 days. Quadruple therapy containing metronidazole, tetracycline and bismuth achieved optimal eradication rates only when prescribed as third-line treatment, either as 10- day single- capsule therapy (87%) or as 14-day traditional therapy with tetracycline hydrochloride (95%). Triple amoxicillin- levofloxacin therapy achieved 90% effectiveness in Eastern Europe only or when optimised. The overall incidence of adverse events was 31%. Conclusion: Empirical rescue treatment in third and subsequent lines achieved suboptimal effectiveness in most European regions. Only quadruple bismuth- metronidazole-tetracycline (10- day single-capsule or 14-day traditional scheme) and triple amoxicillin-levofloxacin therapies reached acceptable outcomes in some settings. Compliance with empirical therapy optimisation principles is still poor 5 years after clinical practice guidelines update.

Helicobacter pylori ; antibiotic therapy ; drug resistance ; proton pump inhibition ; antibiotics

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