European Registry on Helicobacter pylori Management: Effectiveness of First and Second-Line Treatment in SpainMaría Caldas 1 , Ángeles Pérez-Aisa 2 , Manuel Castro-Fernández 3 , Luis Bujanda 4 , Alfredo J Lucendo 5 , Luis Rodrigo 6 , Jose M Huguet 7 , Jorge Pérez-Lasala 8 , Javier Molina-Infante 9 , Jesús Barrio 10 , Luis Fernández-Salazar 11 , Ángel Lanas 12 , Mónica Perona 13 , Manuel Domínguez-Cajal 14 , Juan Ortuño 15 , Blas José Gómez-Rodríguez 16 , Pedro Almela 17 , Josep María Botargués 18 , Óscar Núñez 19 , Inés Modolell 20 , Judith Gómez 21 , Rafael Ruiz-Zorrilla 22 , Cristóbal De la Coba 23 , Alain Huerta 24 , Eduardo Iyo 25 , Liliana Pozzati 26 , Rosario Antón 27 , Mercé Barenys 28 , Teresa Angueira 5 , Miguel Fernández-Bermejo 29 , Ana Campillo 30 , Javier Alcedo 31 , Ramón Pajares-Villaroya 32 , Marianela Mego 33 , Fernando Bermejo 34 , José Luis Dominguez-Jiménez 35 , Llúcia Titó 36 , Nuria Fernández 2 , Manuel Pabón-Carrasco 37 , Ángel Cosme 4 , Pilar Mata-Romero 9 , Noelia Alcaide 11 , Inés Ariño 12 , Tommaso Di Maira 15 , Ana Garre 1 , Ignasi Puig 38 , Olga P Nyssen 1 , Francis Megraud 39 , Colm O'Morain 40 , Javier P Gisbert 1 , Hp-EuReg InvestigatorsAntibiotics (Basel). 2020 Dec 25;10(1):13. doi: 10.3390/antibiotics10010013.
AbstractThe management of Helicobacter pylori infection has to rely on previous local effectiveness due to the geographical variability of antibiotic resistance. The aim of this study was to evaluate the effectiveness of first and second-line H. pylori treatment in Spain, where the empirical prescription is recommended. A multicentre prospective non-interventional registry of the clinical practice of European gastroenterologists concerning H. pylori infection (Hp-EuReg) was developed, including patients from 2013 until June 2019. Effectiveness was evaluated descriptively and through a multivariate analysis concerning age, gender, presence of ulcer, proton-pump inhibitor (PPI) dose, therapy duration and compliance. Overall, 53 Spanish hospitals were included, and 10,267 patients received a first-line therapy. The best results were obtained with the 10-day bismuth single-capsule therapy (95% cure rate by intention-to-treat) and with both the 14-day bismuth-clarithromycin quadruple (PPI-bismuth-clarithromycin-amoxicillin, 91%) and the 14-day non-bismuth quadruple concomitant (PPI-clarithromycin-amoxicillin-metronidazole, 92%) therapies. Second-line therapies were prescribed to 2448 patients, with most-effective therapies being the triple quinolone (PPI-amoxicillin-levofloxacin/moxifloxacin) and the bismuth-levofloxacin quadruple schemes (PPI-bismuth-levofloxacin-amoxicillin) prescribed for 14 days (92%, 89% and 90% effectiveness, respectively), and the bismuth single-capsule (10 days, 88.5%). Compliance, longer duration and higher acid inhibition were associated with higher effectiveness. 'Optimized' H. pylori therapies achieve over 90% success in Spain.Keywords: Helicobacter pylori; Spain; first-line; second-line; treatment.
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