<i>Helicobacter pylori</i>first‐line and rescue treatments in patients allergic to penicillin: Experience from the European Registry on<i>H pylori</i>management (Hp‐EuReg)
Olga P. Nyssen, Ángeles Pérez‐Aísa, Bojan Tepeš, Luı́s Rodrigo, Pilar Mata Romero, Alfredo J. Lucendo, Manuel Castro‐Fernández, Perminder Phull, Jésus Barrio, Luís Bujanda, Juan Ortuño, Miguel Areia, Nataša Brglez Jurečič, José María Huguet, Noelia Alcaide, Irina Voynovan, Jose Maria Botargues Bote, Inés Modolell, Jorge Pérez Lasala, Inés Ariño, Laimas Virginijus Jonaitis, Manuel Domínguez‐Cajal, György Miklós Buzás, Frode Lerang, Mónica Perona, Д.С. Бордин, Toni Axon, Antonio Gasbarrini, Ricardo Marcos Pinto, Yaron Niv, Limas Kupčinskas, Ante Tonkić, Mārcis Leja, Theodore Rokkas, Lyudmila Boyanova, Oleg Shvets, Marino Venerito, Peter Bytzer, Adrian Goldiș, İlkay Şımşek, Vincent Lamy, Krzysztof Przytulski, Lumír Kunovský, Lisette G. Capelle, Tomica Milosavljević, María Caldas, Ana Garre, Françis Mégraud, Colm O’Morain, Javier P. Gisbert, the Hp‐EuReg Investigators
Abstract
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: ; 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.