Eradication Rates of Empiric Helicobacter pylori Treatment Regimens by Race/Ethnicity in a Predominantly Immigrant U.S. Population.

BACKGROUND

Helicobacter pylori infections are mostly treated empirically (without antibiotic susceptibility testing). Determining eradication rates of different treatment regimens can inform antibiotic resistance. Our aim was to examine eradication rates of empiric H. pylori treatments based on treatment regimen, race/ethnicity and previous treatment status in a multiethnic U.S.

MATERIALS AND

METHODS

This was a retrospective cross-sectional study of patients with a positive H. pylori test from 7/2021 to 4/2022 at Harris Health (Houston, Texas) who had received treatment and eradication testing within 1 year. We compared eradication rates based on treatment regimen, race/ethnicity, and prior treatment and examined other possible risk factors for treatment failure using logistic regression models.

RESULTS

Among 1106 H. pylori-infected patients, 29.2% were male, 80.6% Hispanic, 10.7% black, 2.5% white, and 83.3% were non-U.S. born with a mean age of 50.8 years (standard deviation 12.6). Most patients (57.3%) received bismuth-tetracycline-metronidazole quadruple, 21.2% clarithromycin-metronidazole-amoxicillin quadruple, 15.6% clarithromycin-amoxicillin triple, and 3.9% received clarithromycin-metronidazole triple therapies. Eradication rates were highest for bismuth-tetracycline-metronidazole quadruple (83.8%), clarithromycin-metronidazole-amoxicillin quadruple (80.3%), and clarithromycin-amoxicillin triple therapies (79.2%). In 186 (16.8%) previously treated patients, all empiric regimens achieved < 80% eradication rates. Clarithromycin-amoxicillin triple had high eradication rates (92.9%) in black patients and bismuth quadruple therapy in Asians (95.8%). Compared to bismuth quadruple therapy, clarithromycin-metronidazole triple (adjusted odds ratio [adjOR] 0.31, 95% confidence interval [CI] 0.13-0.73) and levofloxacin-amoxicillin triple (adjOR 0.20, 95% CI 0.05-0.89) regimens were associated with treatment failure, whereas clarithromycin-amoxicillin quadruple and triple therapies were not.

CONCLUSIONS

Empiric bismuth quadruple therapy had the highest eradication rate while metronidazole and levofloxacin triple therapies had the lowest. Eradication rates may thus serve as a surrogate clinical endpoint when choosing empiric therapies.