A142 TRENDS IN HELICOBACTER PYLORI TREATMENT AND CURE IN EDMONTON: 2015–2020.

Krahn, T; Zanten, S van

Background Therapies for Helicobacter pylori infection have changed significantly over time due to changes in resistance patterns. In 2016, the Toronto H. pylori consensus guidelines recommended treatment for 14 days. First-line therapies are concomitant therapy with a proton-pump inhibitor (PPI) and clarithromycin-amoxicillin-metronidazole (CLAMET) or bismuth-based quadruple therapy (PPI-bismuth-metronidazole-tetracycline, PBMT). Second and/or third line therapies are PBMT or PPI-amoxicillin-levofloxacin (PAL) and the fourth line PPI-amoxicillin-rifabutin (PAR) for 10 days. Aims To describe and compare the efficacy of current treatment regimens for H. pylori infection in Edmonton. Methods This retrospective study reviewed records of patients treated for H. pylori infection at the University of Alberta Hospital (UAH) in Edmonton, Alberta from January 1, 2015 - November 1, 2020. Diagnosis of H. pylori infection and test-of-cure were documented with a positive urea breath test, stool antigen test, histology on endoscopy, or positive culture. Patients who had no post-treatment testing were excluded. The per protocol efficacy of different regimens was calculated as well as cumulative success rates when given as 2nd, 3rd or 4th line therapy. Results Overall, 170 of 237 (71.7 %) confirmed H. pylori cases achieved cure. The majority were female (64%) and 113 (48%) were born outside of Canada. CLAMET initiated at UAH had the highest success rate 41/45 (91%), and in referred patients who were previously treated was successful as first-line therapy in 45/70 (64%). Overall success rate of regimens were as follows (Table 1): CLAMET 49/98 (50%), PBMT 45/114 (40%), PAL 33/99 (33%), and PAR 16/31 (51%). Alternative regimens were not successful 27/223 (12%). Cultures and resistance profiles were available for 53 cases that failed initial treatment. Resistance to clarithromycin (84%), metronidazole (48%), and levofloxacin (41%) was highly prevalent (Figure 1). Conclusions Test-of-cure is important to verify H. pylori eradication as antibiotic resistance is common to clarithromycin, metronidazole, and levofloxacin when prior treatments failed. These results support the H. pylori treatment regimens recommended by the Toronto consensus guidelines. Success of treatment regimens for H. pylori infection Treatment  1st line  2nd line  3rd line  4th line  5th line  Total  CLAMET  45/70 (64%)  4/23 (17%)  0/5 (0%)  NA  NA  49/98 (50%)  PBMT  2/15 (13%)  14/47 (30%)  15/36 (42%)  11/13 (85%)  3/3 (100%)  45/114 (40%)  PAL  1/5 (20%)  11/30 (37%)  11/46 (24%)  8/16 (50%)  2/2 (100%)  33/99 (33%)  PAR  1/1 (100%)  0/1 (0%)  2/6 (33%)  9/19 (47%)  4/4 (100%)  16/31 (52%)  Alternative regimens  18/146 (12%)  3/53 (6%)  1/13 (8%)  5/10 (50%)  0/1 (0%)  27/223 (12%)  Treatment  1st line  2nd line  3rd line  4th line  5th line  Total  CLAMET  45/70 (64%)  4/23 (17%)  0/5 (0%)  NA  NA  49/98 (50%)  PBMT  2/15 (13%)  14/47 (30%)  15/36 (42%)  11/13 (85%)  3/3 (100%)  45/114 (40%)  PAL  1/5 (20%)  11/30 (37%)  11/46 (24%)  8/16 (50%)  2/2 (100%)  33/99 (33%)  PAR  1/1 (100%)  0/1 (0%)  2/6 (33%)  9/19 (47%)  4/4 (100%)  16/31 (52%)  Alternative regimens  18/146 (12%)  3/53 (6%)  1/13 (8%)  5/10 (50%)  0/1 (0%)  27/223 (12%)  Legend: success rate shown in brackets. Abbreviations as follows: CLAMET, PPI-amoxicillin-metronidazole-clarithromycin; PBMT, PPI-bismuth-metronidazole-tetracycline; PAL, PPI-amoxicillin-levofloxacin; PAR, PPI-amoxicillin-rifabutin; NA, not applicable. Open in new tab Success of treatment regimens for H. pylori infection Treatment  1st line  2nd line  3rd line  4th line  5th line  Total  CLAMET  45/70 (64%)  4/23 (17%)  0/5 (0%)  NA  NA  49/98 (50%)  PBMT  2/15 (13%)  14/47 (30%)  15/36 (42%)  11/13 (85%)  3/3 (100%)  45/114 (40%)  PAL  1/5 (20%)  11/30 (37%)  11/46 (24%)  8/16 (50%)  2/2 (100%)  33/99 (33%)  PAR  1/1 (100%)  0/1 (0%)  2/6 (33%)  9/19 (47%)  4/4 (100%)  16/31 (52%)  Alternative regimens  18/146 (12%)  3/53 (6%)  1/13 (8%)  5/10 (50%)  0/1 (0%)  27/223 (12%)  Treatment  1st line  2nd line  3rd line  4th line  5th line  Total  CLAMET  45/70 (64%)  4/23 (17%)  0/5 (0%)  NA  NA  49/98 (50%)  PBMT  2/15 (13%)  14/47 (30%)  15/36 (42%)  11/13 (85%)  3/3 (100%)  45/114 (40%)  PAL  1/5 (20%)  11/30 (37%)  11/46 (24%)  8/16 (50%)  2/2 (100%)  33/99 (33%)  PAR  1/1 (100%)  0/1 (0%)  2/6 (33%)  9/19 (47%)  4/4 (100%)  16/31 (52%)  Alternative regimens  18/146 (12%)  3/53 (6%)  1/13 (8%)  5/10 (50%)  0/1 (0%)  27/223 (12%)  Legend: success rate shown in brackets. Abbreviations as follows: CLAMET, PPI-amoxicillin-metronidazole-clarithromycin; PBMT, PPI-bismuth-metronidazole-tetracycline; PAL, PPI-amoxicillin-levofloxacin; PAR, PPI-amoxicillin-rifabutin; NA, not applicable. Open in new tab Figure 1. Open in new tab Download slide Rates of antibiotic resistance in H. pylori cultures (n=53). Figure 1. Open in new tab Download slide Rates of antibiotic resistance in H. pylori cultures (n=53). Funding Agencies None

EDMONTON (Alta.); HELICOBACTER pylori; PROTON pump inhibitors; CLARITHROMYCIN; METRONIDAZOLE

Journal of the Canadian Association of Gastroenterology, 2021, Vol 4, p129

2515-2092

Academic Journal

10.1093/jcag/gwab002.140