Olga P Nyssen1, Ángeles Pérez-Aisa2,3, Bojan Tepes4, Luis Rodrigo-Sáez5, Pilar M Romero6, Alfredo Lucendo7, Manuel Castro-Fernández8, Perminder Phull9, Jesús Barrio10, Luis Bujanda11, Juan Ortuño12, Miguel Areia13, Natasa Brglez Jurecic14, José María Huguet15, Noelia Alcaide16, Irina Voynovan17, José María Botargues Bote18, Inés Modolell19, Jorge Pérez Lasala20, Inés Ariño21, Laimas Jonaitis22, Manuel Dominguez-Cajal23, György Buzas24, Frode Lerang25, Monica Perona26, Dmitry Bordin17, Toni Axon27, Antonio Gasbarrini28, Ricardo Marcos Pinto29, Yaron Niv30, Limas Kupcinskas22, Ante Tonkic31, Marcis Leja32, Theodore Rokkas33, Lyudmila Boyanova34, Oleg Shvets35, Marino Venerito36, Peter Bytzer37, Adrian Goldis38, Ilkay Simsek39, Vincent Lamy40, Krzysztof Przytulski41, Lumír Kunovský42, Lisette Capelle43, Tomica Milosavljevic44, María Caldas1, Ana Garre1, Francis Mégraud45, Colm O'Morain46, Javier P Gisbert1. 1. Gastroenterology Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain. 2. Digestive Unit, Agencia Sanitaria Costa del Sol, Marbella, Spain. 3. Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Málaga, Spain. 4. Gastroenterology Unit, AM DC Rogaska, Rogaska Slatina, Slovenia. 5. Gastroenterology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain. 6. Hospital San Pedro de Alcántara, Cáceres, Spain. 7. Hospital de Tomelloso (Ciudad Real), Sevilla, Spain. 8. Hospital de Valme, Sevilla, Spain. 9. Aberdeen Royal Infirmary, Aberdeen, UK. 10. Hospital Río Hortega, Valladolid, Spain. 11. Department of Gastroenterology, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), Donosti, Spain. 12. Hospital Universitari i Politècnic La Fe, Valencia, Spain. 13. Portuguese Oncology Institute, Coimbra, Portugal. 14. Diagnostic Centre Bled, Bled, Slovenia. 15. Hospital General Universitario de Valencia, Valencia, Spain. 16. Hospital Clínico Universitario Valladolid, Valladolid, Spain. 17. Department of Pancreatobiliary and Upper GI Diseases, Moscow Clinical Scientific Center, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia. 18. Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain. 19. Consorci Sanitari Terrassa, Terrassa, Spain. 20. HM Sanchinarro, Madrid, Spain. 21. Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain. 22. Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania. 23. Hospital de San Jorge, Huesca, Spain. 24. Gastroenterology Unit, Ferencváros Policlinic, Budapest, Hungary. 25. Medical Department, Central Hospital Ostfold, Fredrikstad, Norway. 26. Hospital Quiron Marbella, Marbella, Spain. 27. Gastroenterology Unit, University of Leeds, Leeds, UK. 28. Gastronterology Area, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy. 29. Centro Hospitalar do Porto, Institute of Biomedical Sciences Abel Salazar, University of Porto and CINTESIS, University of Porto, Porto, Portugal. 30. Department of Gastroenterology, Rabin Medical Center, Tel Aviv University, Petach Tikva, Israel. 31. Department of Gastroenterology, School of Medicine, University Hospital of Split, University of Split, Split, Croatia. 32. Faculty of Medicine, Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia. 33. Gastroenterology Unit, Henry Dunant Hospital, Athens, Greece. 34. Department of Medical Microbiology, Medical University of Sofia, Sofia, Bulgaria. 35. Internal Diseases Department No. 1, National Medical University named after O.O. Bogomolets, Kyiv, Ukraine. 36. Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany. 37. Department of Medicine, Zealand University Hospital, Copenhagen University, Copenhagen, Denmark. 38. Gastroenterology Unit, Timisoara Hospital, Timisoara, Romania. 39. Hacettepe University Faculty of Medicine, Ankara, Turkey. 40. Department of Gastroenterology, Hepatology & Nutrition, CHU Charleroi, Charleroi, Belgium. 41. Gastroenterology Unit, Medical Centre for Postgraduate Education, Warsaw, Poland. 42. Department of Gastroenterology and Internal Medicine and Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic. 43. Gastroenterology and Hepatology, Erasmus MC University, Rotterdam, The Netherlands. 44. Medical Department, Clinical Center of Serbia Clinic for Gastroenterology and Hepatology, University of Belgrade, Belgrade, Serbia. 45. Laboratoire de Bactériologie, Hôpital Pellegrin, Bordeaux Cedex, France. 46. Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland.
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: 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.
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 penicillinallergy 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.
Authors: María Caldas; Ángeles Pérez-Aisa; Manuel Castro-Fernández; Luis Bujanda; Alfredo J Lucendo; Luis Rodrigo; Jose M Huguet; Jorge Pérez-Lasala; Javier Molina-Infante; Jesús Barrio; Luis Fernández-Salazar; Ángel Lanas; Mónica Perona; Manuel Domínguez-Cajal; Juan Ortuño; Blas José Gómez-Rodríguez; Pedro Almela; Josep María Botargués; Óscar Núñez; Inés Modolell; Judith Gómez; Rafael Ruiz-Zorrilla; Cristóbal De la Coba; Alain Huerta; Eduardo Iyo; Liliana Pozzati; Rosario Antón; Mercé Barenys; Teresa Angueira; Miguel Fernández-Bermejo; Ana Campillo; Javier Alcedo; Ramón Pajares-Villaroya; Marianela Mego; Fernando Bermejo; José Luis Dominguez-Jiménez; Llúcia Titó; Nuria Fernández; Manuel Pabón-Carrasco; Ángel Cosme; Pilar Mata-Romero; Noelia Alcaide; Inés Ariño; Tommaso Di Maira; Ana Garre; Ignasi Puig; Olga P Nyssen; Francis Megraud; Colm O'Morain; Javier P Gisbert Journal: Antibiotics (Basel) Date: 2020-12-25