TY - JOUR

T1 - Helicobacter pylori first-line and rescue treatments in patients allergic to penicillin

T2 - Experience from the European Registry on H pylori management (Hp-EuReg)

AU - Nyssen, Olga P.

AU - Pérez-Aisa, Ángeles

AU - Tepes, Bojan

AU - Rodrigo-Sáez, Luis

AU - Romero, Pilar M.

AU - Lucendo, Alfredo

AU - Castro-Fernández, Manuel

AU - Phull, Perminder

AU - Barrio, Jesús

AU - Bujanda, Luis

AU - Ortuño, Juan

AU - Areia, Miguel

AU - Brglez Jurecic, Natasa

AU - Huguet, José María

AU - Alcaide, Noelia

AU - Voynovan, Irina

AU - María Botargues Bote, José

AU - Modolell, Inés

AU - Pérez Lasala, Jorge

AU - Ariño, Inés

AU - Jonaitis, Laimas

AU - Dominguez-Cajal, Manuel

AU - Buzas, György

AU - Lerang, Frode

AU - Perona, Monica

AU - Bordin, Dmitry

AU - Axon, Toni

AU - Gasbarrini, Antonio

AU - Marcos Pinto, Ricardo

AU - Niv, Yaron

AU - Kupcinskas, Limas

AU - Tonkic, Ante

AU - Leja, Marcis

AU - Rokkas, Theodore

AU - Boyanova, Lyudmila

AU - Shvets, Oleg

AU - Venerito, Marino

AU - Bytzer, Peter

AU - Goldis, Adrian

AU - Simsek, Ilkay

AU - Lamy, Vincent

AU - Przytulski, Krzysztof

AU - Kunovský, Lumír

AU - Capelle, Lisette

AU - Milosavljevic, Tomica

AU - Caldas, María

AU - Garre, Ana

AU - Mégraud, Francis

AU - O'Morain, Colm

AU - Gisbert, Javier P.

AU - the Hp-EuReg Investigators

N1 - Publisher Copyright: © 2020 John Wiley & Sons Ltd

PY - 2020

Y1 - 2020

N2 - 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.

AB - 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.

KW - allergic

KW - allergy

KW - bismuth

KW - clarithromycin

KW - Helicobacter pylori

KW - levofloxacin

KW - penicillin

UR - http://www.scopus.com/inward/record.url?scp=85081728684&partnerID=8YFLogxK

U2 - 10.1111/hel.12686

DO - 10.1111/hel.12686

M3 - Journal article

C2 - 32173974

AN - SCOPUS:85081728684

VL - 25

JO - Helicobacter

JF - Helicobacter

SN - 1083-4389

IS - 3

M1 - e12686

ER -