Helicobacter pylori first-line and rescue treatments in patients allergic to penicillin: Experience from the European Registry on H pylori management (Hp-EuReg).
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Nyssen Olga P, Pérez-Aisa Ángeles, Tepes Bojan, Rodrigo-Sáez Luis, Romero Pilar M, Lucendo Alfredo, Castro-Fernández Manuel, Phull Perminder, Barrio Jesús, Bujanda Luis, Ortuño Juan, Areia Miguel, Brglez Jurecic Natasa, Huguet José María, Alcaide Noelia, Voynovan Irina, María Botargues Bote José, Modolell Inés, Pérez Lasala Jorge, Ariño Inés, Jonaitis Laimas, Dominguez-Cajal Manuel, Buzas György, Lerang Frode, Perona Monica, Bordin Dmitry, Axon Toni, Gasbarrini Antonio, Marcos Pinto Ricardo, Niv Yaron, Kupcinskas Limas, Tonkic Ante, Leja Marcis, Rokkas Theodore, Boyanova Lyudmila, Shvets Oleg, Venerito Marino, Bytzer Peter, Goldis Adrian, Simsek Ilkay, Lamy Vincent, Przytulski Krzysztof, Kunovský Lumír, Capelle Lisette, Milosavljevic Tomica, Caldas María, Garre Ana, Mégraud Francis, O'Morain Colm, Gisbert Javier P, Hp-EuReg Investigators
Аннотация
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.