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. 2024 Oct 29;8(3):BJGPO.2023.0252.
doi: 10.3399/BJGPO.2023.0252. Print 2024 Oct.

Treatment failure of Helicobacter pylori in primary care: a retrospective cohort study

Gertrude van den Brink  1 , Lieke M Koggel  2 , Joris Jh Hendriks  2 , Mark Gj de Boer  3 , Peter D Siersema  2   4 , Mattijs E Numans  5
Affiliations

Treatment failure of Helicobacter pylori in primary care: a retrospective cohort study

Gertrude van den Brink et al. BJGP Open. .

Abstract

Background: Owing to increasing antibiotic resistance, the worldwide efficacy of Helicobacter pylori (HP) eradication treatment has decreased.

Aim: To determine antimicrobial resistance of HP in primary care.

Design & setting: Retrospective cohort study using real-world routine healthcare data from 80 general practices in the Netherlands.

Method: Patients with International Classification of Primary Care (ICPC) codes for gastric symptoms or Anatomical Therapeutic Chemical (ATC) codes for acid inhibition in the period 2010-2020 were selected. Main outcomes were antimicrobial resistance of HP, defined as the prescription of a second eradication treatment within 12 months, and clinical remission of gastric symptoms, defined as no usage of acid inhibition 1 year following eradication therapy.

Results: We identified 138 455 patients with gastric symptoms and/or acid inhibition use (mean age 57 years [standard deviation 18.2 years], 43% male). A total of 5224 (4%) patients received an HP eradication treatment. A second treatment was prescribed to 416 (8%) of those patients. From these, 380 patients received amoxicillin-clarithromycin, 16 amoxicillin-metronidazole, and 11 clarithromycin-metronidazole as first regimen and were considered antimicrobial resistant. We observed a 0.8% increment per year of patients requiring a second eradication treatment (P = 0.003, 95% confidence interval = 0.33 to 1.22). After successful eradication, 2329/4808 (48%) patients used acid inhibition compared with 355/416 (85%) patients following treatment failure (P<0.001).

Conclusion: Antimicrobial treatment is not successful in almost one-tenth of HP infections in primary care after a first treatment containing clarithromycin and/or metronidazole. Although the treatment failure rate is not as high as reported in secondary care, the increasing trend is concerning and may require revision of the current guidelines.

Keywords: Helicobacter pylori; primary health care; treatment failure.

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Conflict of interest statement

Peter D Siersema has received research funding from Pentax, The E-Nose company, Lucid Diagnostics, Micro-Tech, Motus GI, Magentiq Eye, Norgine, and Endo Tools Therapeutics; and consultancy fees from Motus GI and Magentiq Eye. The remaining authors have declared no competing interests.

Figures

Figure 1.
Figure 1.. Patient selection
Figure 2.
Figure 2.. Helicobacter pylori (HP) eradication treatments: a) first HP eradication treatment; b) second HP eradication treatment; and c) initial antibiotic regimes of patients that received a second eradication treatment
Figure 3.
Figure 3.. Percentage of Helicobacter pylori treatment failure over the years 2011–2019
See this image and copyright information in PMC

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References

    1. Mladenova I. Clinical relevance of Helicobacter pylori infection. J Clin Med. 2021; 10 (16):3473. doi: 10.3390/jcm10163473. - DOI - PMC - PubMed
    1. Kao CY, Sheu BS, Wu JJ. Helicobacter Pylori infection: an overview of bacterial virulence factors and pathogenesis. Biomed J. 2016; 39 (1):14–23. doi: 10.1016/j.bj.2015.06.002. - DOI - PMC - PubMed
    1. Yokota S, Konno M, Fujiwara 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; 20 (5):334–342. doi: 10.1111/hel.12217. - DOI - PubMed
    1. Zamani M, Ebrahimtabar F, Zamani V, et al. Systematic review with meta-analysis: the worldwide prevalence of Helicobacter pylori infection. Aliment Pharmacol Ther. 2018; 47 (7):868–876. doi: 10.1111/apt.14561. - DOI - PubMed
    1. Hooi JKY, Lai WY, Ng WK, et al. Global prevalence of Helicobacter Pylori infection: systematic review and meta-analysis. Gastroenterology. 2017; 153 (2):420–429. doi: 10.1053/j.gastro.2017.04.022. - DOI - PubMed

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