Helicobacter pylori Eradication Primary Care First-Line Prescriptions: Data From 200,000 Patients in a Real-World Cohort.

BACKGROUND

Helicobacter pylori is a common infection primarily managed in primary care. Assessing real-world practices and guideline adherence is crucial for treatment optimisation. The study aims to assess current H. pylori management strategies using data from BIFAP, a Spanish primary care database.

MATERIALS AND

METHODS

Cohort study including patients aged ≥ 18 with recorded H. pylori infection (2003-2023) and corresponding treatment prescriptions. Infection cases were identified using ICD-9/10 and SNOMED-CT codes. Treatment patterns were based on Spanish and European guidelines. First-line treatment prescriptions were compared between primary (BIFAP) and specialized (European Registry, Hp-EuReg) care.

RESULTS

A total of 211,972 H. pylori-infected subjects were identified. Over the study period (20 years), the predominant first-line treatments were: bismuth quadruple therapy including a proton-pump inhibitor (PPI) plus a single capsule containing bismuth-tetracycline-metronidazole (36%); PPI + clarithromycin-amoxicillin (30%); and PPI + clarithromycin-amoxicillin-metronidazole (26%). Single-capsule bismuth quadruple therapy was the most common in patients aged 18-64 and those with obesity, chronic kidney disease, or smokers, while PPI + clarithromycin-amoxicillin was more common in those aged ≥ 65 or with peptic ulcers. Since 2013, PPI + clarithromycin-amoxicillin use by general practitioners and gastroenterologists decreased, though it remained above 10% in primary care at study end. PPI + clarithromycin-amoxicillin-metronidazole increased since 2015, with higher use in specialized care (40%) vs. primary care (30%). In 2023, single-capsule bismuth quadruple therapy was the most prescribed regimen in both settings, accounting for ~60% of prescriptions.

CONCLUSIONS

Primary care H. pylori treatments are varied, with single-capsule bismuth quadruple therapy most prescribed. Guidelines are followed, but adoption is slower in primary than in specialized care.