Premium
Bismuth quadruple regimen with tetracycline or doxycycline versus three‐in‐one single capsule as third‐line rescue therapy for Helicobacter pylori infection: Spanish data of the European Helicobacter pylori Registry (Hp‐EuReg)
Author(s) -
Nyssen Olga P.,
PerezAisa Angeles,
Rodrigo Luis,
Castro Manuel,
Mata Romero Pilar,
Ortuño Juan,
Barrio Jesus,
Huguet Jose Maria,
Modollel Ines,
Alcaide Noelia,
Lucendo Alfredo,
Calvet Xavier,
Perona Monica,
Gomez Barbara,
Gomez Rodriguez Blas Jose,
Varela Pilar,
JimenezMoreno Manuel,
DominguezCajal Manuel,
Pozzati Liliana,
BurgosSantamaria Diego,
Bujanda Luis,
Hinojosa Jenifer,
MolinaInfante Javier,
Di Maira Tommaso,
Ferrer Luis,
FernándezSalazar Luis,
Figuerola Ariadna,
Tito Llucia,
Coba Cristobal,
GomezCamarero Judith,
Fernandez Nuria,
Caldas Maria,
Garre Ana,
Resina Elena,
Puig Ignasi,
O’Morain Colm,
Megraud Francis,
Gisbert Javier P.
Publication year - 2020
Publication title -
helicobacter
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 79
eISSN - 1523-5378
pISSN - 1083-4389
DOI - 10.1111/hel.12722
Subject(s) - metronidazole , helicobacter pylori , medicine , clarithromycin , regimen , levofloxacin , doxycycline , gastroenterology , tetracycline , antibiotics , surgery , microbiology and biotechnology , biology
Background Different bismuth quadruple therapies containing proton‐pump inhibitors, bismuth salts, metronidazole, and a tetracycline have been recommended as third‐line Helicobacter pylori eradication treatment after failure with clarithromycin and levofloxacin. Aim To evaluate the efficacy and safety of third‐line treatments with bismuth, metronidazole, and either tetracycline or doxycycline. Methods Sub‐study with Spanish data of the “European Registry on H pylori Management” (Hp‐EuReg), international multicenter prospective non‐interventional Registry of the routine clinical practice of gastroenterologists. After previous failure with clarithromycin‐ and levofloxacin‐containing therapies, patients receiving a third‐line regimen with 10/14‐day bismuth salts, metronidazole, and either tetracycline (BQT‐Tet) or doxycycline (BQT‐Dox), or single capsule (BQT‐three‐in‐one) were included. Data were registered at AEG‐REDCap database. Univariate and multivariate analyses were performed. Results Four‐hundred and fifty‐four patients have been treated so far: 85 with BQT‐Tet, 94 with BQT‐Dox, and 275 with BQT‐three‐in‐one. Average age was 53 years, 68% were women. Overall modified intention‐to‐treat and per‐protocol eradication rates were 81% (BQT‐Dox: 65%, BQT‐Tet: 76%, BQT‐three‐in‐one: 88%) and 82% (BQT‐Dox: 66%, BQT‐Tet: 77%, BQT‐three‐in‐one: 88%), respectively. By logistic regression, higher eradication rates were associated with compliance (OR = 2.96; 95% CI = 1.01‐8.84) and no prior metronidazole use (OR = 1.96; 95% CI = 1.15‐3.33); BQT‐three‐in‐one was superior to BQT‐Dox (OR = 4.46; 95% CI = 2.51‐8.27), and BQT‐Tet was marginally superior to BQT‐Dox (OR = 1.67; 95% CI = 0.85‐3.29). Conclusion Third‐line H pylori eradication with bismuth quadruple treatment (after failure with clarithromycin and levofloxacin) offers acceptable efficacy and safety. Highest efficacy was found in compliant patients and those taking 10‐day BQT‐three‐in‐one or 14‐day BQT‐Tet. Doxycycline seems to be less effective and therefore should not be recommended.