Helicobacter pylori first-line and rescue treatments in patients allergic to penicillin: Experience from the European Registry on H pylori management (Hp-EuReg)

• Autoři: NYSSEN O. P.; PEREZ-AISA A.; TEPES B.; RODRIGO-SAEZ L.; ROMERO P. M.; LUCENDO A.; CASTRO-FERNANDEZ M.; PHULL P.; BARRIO J.; BUJANDA L.; ORTUNO J.; AREIA M.; JURECIC N. B.; HUGUET J. M.; ALCAIDE N.; VOYNOVAN I.; BOTE J. M. B.; MODOLELL I.; LASALA J. P.; ARINO I.; JONAITIS L.; DOMINGUEZ-CAJAL M.; BUZAS G.; LERANG F.; PERONA M.; BORDIN D.; AXON T.; GASBARRINI A.; PINTO R. M.; NIV Y.; KUPCINSKAS L.; TONKIC A.; LEJA M.; ROKKAS T.; BOYANOVA L.; SHVETS O.; VENERITO M.; BYTZER P.; GOLDIS A.; SIMSEK I.; LAMY V.; PRZYTULSKI K.; KUNOVSKÝ Lumír; CAPELLE L.; MILOSAVLJEVIC T.; CALDAS M.; GARRE A.; MEGRAUD F.; O'MORAIN C.; GISBERT J. P.
• Rok publikování: 2020
• Druh: Článek v odborném periodiku
• Časopis / Zdroj: Helicobacter
• Fakulta / Pracoviště MU: Lékařská fakulta
• www: https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/hel.12686
• Doi: http://dx.doi.org/10.1111/hel.12686
• Klíčová slova: allergic; allergy; bismuth; clarithromycin; Helicobacter pylori; levofloxacin; penicillin
• Popis: 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(R); 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.