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

Autori
Nyssen, OP ; Perez-Aisa, A ; Tepes, B ; Rodrigo-Saez, L ; Romero, PM ; Lucendo, A ; Castro-Fernandez, M ; Phull, P ; Barrio, J ; Bujanda, L ; Ortuno, J ; Areia, M ; Jurecic, NB ; Huguet, JM ; Alcaide, N ; Voynovan, I ; Bote, JMB ; Modolell, I ; Lasala, JP ; Arino, I ; Jonaitis, L ; Dominguez-Cajal, M ; Buzas, G ; Lerang, F ; Perona, M ; Bordin, D ; Axon, T ; Gasbarrini, A ; Pinto, RM ; Niv, Y ; Kupcinskas, L ; Tonkić, A ; Leja, M ; Rokkas, T ; Boyanova, L ; Shvets, O ; Venerito, M ; Bytzer, P ; Goldis, A ; Simsek, I ; Lamy, V ; Przytulski, K ; Kunovsky, L ; Capelle, L ; Milosavljevic, T ; Caldas, M ; Garre, A ; Megraud, F ; O'Morain, C ; Gisbert, JP

Kolaboracija
Hp-EuReg Investigators

Izvornik
Helicobacter (Cambridge, Mass.) (1083-4389) 25 (2020), 3; E12686, 11

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, znanstveni

Ključne riječi
allergic ; allergy ; bismuth ; clarithromycin ; Helicobacter pylori ; levofloxacin ; penicillin

Sažetak
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(R) ; 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.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA