Original article
Vol. 153 No. 1 (2023)
Clarithromycin-based Helicobacter pylori eradication therapy is not associated with higher treatment failure compared with non-clarithromycin-based regimens in a tertiary referral hospital in Switzerland
- Tobias Braendli
- Valeria Schindler
- Dominique Laurent Braun
- Fritz R. Murray
- Juliane Marie Hente
- Daniel Pohl
Summary
BACKGROUND AND AIMS: Due to increasing antibiotic resistance, various Helicobacter pylori eradication regimens other than clarithromycin-based therapies have been proposed. However, detailed data on which therapies were employed and their eradication success is lacking. The purpose of this study was to analyse the response rates of different eradication therapy schemes.
METHODS: In this retrospective cohort study, we analysed data of 1721 patients and included 608 patients undergoing H. pylori eradication therapy at the Department of Gastroenterology at the University Hospital Zurich between 2004 and 2018. The primary endpoint was the success rates of clarithromycin- and non-clarithromycin-containing H. pylori eradication regimens. We furthermore analysed factors with potential impact on the outcome of H. pylori eradication therapies, such as demographics, and smoking and social status.
RESULTS: The most common therapy scheme (71% of all cases) was proton pump inhibitor (PPI)-amoxicillin-metronidazole, followed by PPI-amoxicillin-clarithromycin (21%) and PPI-metronidazole-clarithromycin (6%). There was no difference between the H. pylori eradication success of clarithromycin vs non-clarithromycin-containing therapies (71% vs 71%, p = 0.764).
CONCLUSION: Despite increasing clarithromycin resistance globally, there was no difference in the eradication success of clarithromycin- and non-clarithromycin-containing therapy regimens in Switzerland. As varying triple therapies do not increase eradication rates in real-world settings, other primary therapy options such as quadruple therapies should be explored.
References
- Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet. 1984 Jun;1(8390):1311–5. https://doi.org/10.1016/S0140-6736(84)91816-6
DOI: https://doi.org/10.1016/S0140-6736(84)91816-6
- Yokota S, Konno M, Fujiwara S, Toita N, Takahashi M, Yamamoto S, et al. Intrafamilial, Preferentially Mother-to-Child and Intraspousal, Helicobacter pylori Infection in Japan Determined by Mutilocus Sequence Typing and Random Amplified Polymorphic DNA Fingerprinting. Helicobacter. 2015 Oct;20(5):334–42. https://doi.org/10.1111/hel.12217
DOI: https://doi.org/10.1111/hel.12217
- Malfertheiner P, Megraud F, O’Morain CA, Gisbert JP, Kuipers EJ, Axon AT, et al.; European Helicobacter and Microbiota Study Group and Consensus panel. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut. 2017 Jan;66(1):6–30. https://doi.org/10.1136/gutjnl-2016-312288
DOI: https://doi.org/10.1136/gutjnl-2016-312288
- Krumbiegel P, Lehmann I, Alfreider A, Fritz GJ, Boeckler D, Rolle-Kampczyk U, et al. Helicobacter pylori determination in non-municipal drinking water and epidemiological findings. Isotopes Environ Health Stud. 2004 Mar;40(1):75–80. https://doi.org/10.1080/10256010310001639868
DOI: https://doi.org/10.1080/10256010310001639868
- McColl KE. Clinical practice. Helicobacter pylori infection. N Engl J Med. 2010 Apr;362(17):1597–604. https://doi.org/10.1056/NEJMcp1001110
DOI: https://doi.org/10.1056/NEJMcp1001110
- Hooi JK, Lai WY, Ng WK, Suen MM, Underwood FE, Tanyingoh D, et al. Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta-Analysis. Gastroenterology. 2017 Aug;153(2):420–9. https://doi.org/10.1053/j.gastro.2017.04.022
DOI: https://doi.org/10.1053/j.gastro.2017.04.022
- Malfertheiner P, Selgrad M, Bornschein J. Helicobacter pylori: clinical management. Curr Opin Gastroenterol. 2012 Nov;28(6):608–14. https://doi.org/10.1097/MOG.0b013e32835918a7
DOI: https://doi.org/10.1097/MOG.0b013e32835918a7
- Megraud F, Coenen S, Versporten A, Kist M, Lopez-Brea M, Hirschl AM, et al.; Study Group participants. Helicobacter pylori resistance to antibiotics in Europe and its relationship to antibiotic consumption. Gut. 2013 Jan;62(1):34–42. https://doi.org/10.1136/gutjnl-2012-302254
DOI: https://doi.org/10.1136/gutjnl-2012-302254
- Soltermann A, Perren A, Schmid S, Eigenmann F, Güller R, Weber KB, et al. Assessment of Helicobacter pylori clarithromycin resistance mutations in archival gastric biopsy samples. Swiss Med Wkly. 2005 May;135(21-22):327–32. https://doi.org/10.4414/smw.2005.10866
DOI: https://doi.org/10.4414/smw.2005.10866
- Zhou Q, Li L, Ai Y, Pan Z, Guo M, Han J. Diagnostic accuracy of the. Wien. Klin Wochenschr. 2017;129(1-2):38–45. https://doi.org/10.1007/s00508-016-1117-3
DOI: https://doi.org/10.1007/s00508-016-1117-3
- Fischbach W, Malfertheiner P, Lynen Jansen P, Bolten W, Bornschein J, Buderus S, et al.; Verantwortlich für die DGVS. [S2k-guideline Helicobacter pylori and gastroduodenal ulcer disease]. Z Gastroenterol. 2016 Apr;54(4):327–63. https://doi.org/10.1055/s-0042-102967
DOI: https://doi.org/10.1055/s-0042-102967
- Suzuki T, Matsuo K, Ito H, Sawaki A, Hirose K, Wakai K, et al. Smoking increases the treatment failure for Helicobacter pylori eradication. Am J Med. 2006 Mar;119(3):217–24. https://doi.org/10.1016/j.amjmed.2005.10.003
DOI: https://doi.org/10.1016/j.amjmed.2005.10.003
- Chey WD, Wong BC; Practice Parameters Committee of the American College of Gastroenterology. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. 2007 Aug;102(8):1808–25. https://doi.org/10.1111/j.1572-0241.2007.01393.x
DOI: https://doi.org/10.1111/j.1572-0241.2007.01393.x
- Jafri NS, Hornung CA, Howden CW. Meta-analysis: sequential therapy appears superior to standard therapy for Helicobacter pylori infection in patients naive to treatment. Ann Intern Med. 2008 Jun;148(12):923–31. https://doi.org/10.7326/0003-4819-148-12-200806170-00226
DOI: https://doi.org/10.7326/0003-4819-148-12-200806170-00226
- Venerito M, Krieger T, Ecker T, Leandro G, Malfertheiner P. Meta-analysis of bismuth quadruple therapy versus clarithromycin triple therapy for empiric primary treatment of Helicobacter pylori infection. Digestion. 2013;88(1):33–45. https://doi.org/10.1159/000350719
DOI: https://doi.org/10.1159/000350719
- Cuadrado-Lavín A, Salcines-Caviedes JR, Diaz-Perez A, Carrascosa MF, Ochagavía M, Fernandez-Forcelledo JL, et al. First-line eradication rates comparing two shortened non-bismuth quadruple regimens against Helicobacter pylori: an open-label, randomized, multicentre clinical trial. J Antimicrob Chemother. 2015 Aug;70(8):2376–81. https://doi.org/10.1093/jac/dkv089
DOI: https://doi.org/10.1093/jac/dkv089
- Molina-Infante J, Lucendo AJ, Angueira T, Rodriguez-Tellez M, Perez-Aisa A, Balboa A, et al.; European Registry on H. pylori management (Hp‐EuReg). Optimised empiric triple and concomitant therapy for Helicobacter pylori eradication in clinical practice: the OPTRICON study. Aliment Pharmacol Ther. 2015 Mar;41(6):581–9. https://doi.org/10.1111/apt.13069
DOI: https://doi.org/10.1111/apt.13069
- Tepes B, Brglez Jurecic N, Tepes K, Espada Sanchez M, Perez Nyssen O, Smith S, et al. Helicobacter pylori eradication rates in Slovenia in the period from 2017 to 2019 - data from the European Registry on Helicobacter pylori Management (Hp-EuReg). Dig Dis. 2020.
- Sánchez-Delgado J, García-Iglesias P, Castro-Fernández M, Bory F, Barenys M, Bujanda L, et al. High-dose, ten-day esomeprazole, amoxicillin and metronidazole triple therapy achieves high Helicobacter pylori eradication rates. Aliment Pharmacol Ther. 2012 Jul;36(2):190–6. https://doi.org/10.1111/j.1365-2036.2012.05137.x
DOI: https://doi.org/10.1111/j.1365-2036.2012.05137.x
- Budzyński J. Helicobacter pylori eradication: not only early consequences. EBioMedicine. 2018 Sep;35:8–9. https://doi.org/10.1016/j.ebiom.2018.08.051
DOI: https://doi.org/10.1016/j.ebiom.2018.08.051
- Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol. 2017 Feb;112(2):212–39. https://doi.org/10.1038/ajg.2016.563
DOI: https://doi.org/10.1038/ajg.2016.563
- Park JY, Dunbar KB, Mitui M, Arnold CA, Lam-Himlin DM, Valasek MA, et al. Helicobacter pylori Clarithromycin Resistance and Treatment Failure Are Common in the USA. Dig Dis Sci. 2016 Aug;61(8):2373–80. https://doi.org/10.1007/s10620-016-4091-8
DOI: https://doi.org/10.1007/s10620-016-4091-8
- Shiota S, Reddy R, Alsarraj A, El-Serag HB, Graham DY. Antibiotic Resistance of Helicobacter pylori Among Male United States Veterans. Clin Gastroenterol Hepatol. 2015 Sep;13(9):1616–24. https://doi.org/10.1016/j.cgh.2015.02.005
DOI: https://doi.org/10.1016/j.cgh.2015.02.005
- Marin AC, McNicholl AG, Gisbert JP. A review of rescue regimens after clarithromycin-containing triple therapy failure (for Helicobacter pylori eradication). Expert Opin Pharmacother. 2013 May;14(7):843–61. https://doi.org/10.1517/14656566.2013.782286
DOI: https://doi.org/10.1517/14656566.2013.782286
- Dore MP, Leandro G, Realdi G, Sepulveda AR, Graham DY. Effect of pretreatment antibiotic resistance to metronidazole and clarithromycin on outcome of Helicobacter pylori therapy: a meta-analytical approach. Dig Dis Sci. 2000 Jan;45(1):68–76. https://doi.org/10.1023/A:1005457226341
DOI: https://doi.org/10.1023/A:1005457226341
- Fischbach L, Evans EL. Meta-analysis: the effect of antibiotic resistance status on the efficacy of triple and quadruple first-line therapies for Helicobacter pylori. Aliment Pharmacol Ther. 2007 Aug;26(3):343–57. https://doi.org/10.1111/j.1365-2036.2007.03386.x
DOI: https://doi.org/10.1111/j.1365-2036.2007.03386.x
- Graham DY, Lee YC, Wu MS. Rational Helicobacter pylori therapy: evidence-based medicine rather than medicine-based evidence. Clin Gastroenterol Hepatol. 2014 Feb;12(2):177–86.e3. https://doi.org/10.1016/j.cgh.2013.05.028
DOI: https://doi.org/10.1016/j.cgh.2013.05.028
- Wu DC, Hsu PI, Tseng HH, Tsay FW, Lai KH, Kuo CH, et al. Helicobacter pylori infection: a randomized, controlled study comparing 2 rescue therapies after failure of standard triple therapies. Medicine (Baltimore). 2011 May;90(3):180–5. https://doi.org/10.1097/MD.0b013e31821c9d1c
DOI: https://doi.org/10.1097/MD.0b013e31821c9d1c
- de Martel C, Parsonnet J. Helicobacter pylori infection and gender: a meta-analysis of population-based prevalence surveys. Dig Dis Sci. 2006 Dec;51(12):2292–301. https://doi.org/10.1007/s10620-006-9210-5
DOI: https://doi.org/10.1007/s10620-006-9210-5
- Naja F, Kreiger N, Sullivan T. Helicobacter pylori infection in Ontario: prevalence and risk factors. Can J Gastroenterol. 2007 Aug;21(8):501–6. https://doi.org/10.1155/2007/462804
DOI: https://doi.org/10.1155/2007/462804
- Perez-Perez GI, Rothenbacher D, Brenner H. Epidemiology of Helicobacter pylori infection. Helicobacter. 2004;9(s1 Suppl 1):1–6. https://doi.org/10.1111/j.1083-4389.2004.00248.x
DOI: https://doi.org/10.1111/j.1083-4389.2004.00248.x
- Bruce MG, Maaroos HI. Epidemiology of Helicobacter pylori infection. Helicobacter. 2008 Oct;13 Suppl 1:1–6. https://doi.org/10.1111/j.1523-5378.2008.00631.x
DOI: https://doi.org/10.1111/j.1523-5378.2008.00631.x
- Malaty HM, Nyren O. Epidemiology of Helicobacter pylori infection. Helicobacter. 2003;8(s1 Suppl 1):8–12. https://doi.org/10.1046/j.1523-5378.2003.00163.x
DOI: https://doi.org/10.1046/j.1523-5378.2003.00163.x
- Suki M, Leibovici Weissman Y, Boltin D, Itskoviz D, Tsadok Perets T, Comaneshter D, et al. Helicobacter pylori infection is positively associated with an increased BMI, irrespective of socioeconomic status and other confounders: a cohort study. Eur J Gastroenterol Hepatol. 2018 Feb;30(2):143–8. https://doi.org/10.1097/MEG.0000000000001014
DOI: https://doi.org/10.1097/MEG.0000000000001014
- Fuccio L, Minardi ME, Zagari RM, Grilli D, Magrini N, Bazzoli F. Meta-analysis: duration of first-line proton-pump inhibitor based triple therapy for Helicobacter pylori eradication. Ann Intern Med. 2007 Oct;147(8):553–62. https://doi.org/10.7326/0003-4819-147-8-200710160-00008
DOI: https://doi.org/10.7326/0003-4819-147-8-200710160-00008
- Graham DY. Transitioning of. Antibiotics (Basel). 2020 Oct;9(10):671. https://doi.org/10.3390/antibiotics9100671
DOI: https://doi.org/10.3390/antibiotics9100671
- Nyssen OP, Bordin D, Tepes B, Pérez-Aisa Á, Vaira D, Caldas M, et al.; Hp-EuReg Investigators. European Registry on Helicobacter pylori management (Hp-EuReg): patterns and trends in first-line empirical eradication prescription and outcomes of 5 years and 21 533 patients. Gut. 2021 Jan;70(1):40–54. https://doi.org/10.1136/gutjnl-2020-321372
DOI: https://doi.org/10.1136/gutjnl-2020-321372
- Li M, Oshima T, Horikawa T, Tozawa K, Tomita T, Fukui H, et al. Systematic review with meta-analysis: Vonoprazan, a potent acid blocker, is superior to proton-pump inhibitors for eradication of clarithromycin-resistant strains of Helicobacter pylori. Helicobacter. 2018 Aug;23(4):e12495. https://doi.org/10.1111/hel.12495
DOI: https://doi.org/10.1111/hel.12495
- Suzuki S, Gotoda T, Takano C, Horii T, Sugita T, Ogura K, et al. Long term impact of vonoprazan-based Helicobacter pylori treatment on gut microbiota and its relation to post-treatment body weight changes. Gut. 2021;69:1019–26. https://doi.org/10.1136/gutjnl-2019-319954
DOI: https://doi.org/10.1111/hel.12851