European Registry on Helicobacter pylori management (Hp-EuReg): First-line Therapy in Israel

• Published in: The Israel Medical Association journal 2021-01, Vol.23 (1), p.38
• Main Authors: Boltin, Doron, Beniashvili, Zaza, Lahat, Adi, Hirsch, Jonathan, Nyssen, Olga P, Mégraud, Francis, O'Morain, Colm, Gisbert, Javier P, Niv, Yaron
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - classification; Clarithromycin - administration & dosage; Dose-Response Relationship, Drug; Drug Therapy, Combination - methods; Drug Therapy, Combination - statistics & numerical data; Female; Helicobacter Infections - diagnosis; Helicobacter Infections - drug therapy; Helicobacter Infections - epidemiology; Helicobacter pylori - drug effects; Humans; Israel - epidemiology; Male; Medication Adherence - statistics & numerical data; Middle Aged; Proton Pump Inhibitors - administration & dosage; Registries - statistics & numerical data; Retreatment - methods; Retreatment - statistics & numerical data; Treatment Outcome
• ISSN: 1565-1088

The antibiotic resistance profile of Helicobacter pylori (H. pylori) is constantly changing. Up-to-date and reliable data for the effectiveness of first-line H. pylori treatment protocols are necessary to provide evidence-based best-practice guidelines. To determine the effectiveness, compliance and safety of first-line treatment for H. pylori in Israel. An observational, prospective, multicenter study was conducted in tertiary referral centers in Israel, as part of the European registry on H. pylori management (Hp-EuReg). H. pylori-infected patients were included from 2013 to March 2020. Data collected included demographics, clinical data, diagnostic tests, previous eradication attempts, current treatment, compliance, adverse events, and treatment outcome result. In total, 242 patients were registered, including 121 (50%) who received first-line therapy, 41% of these individuals received clarithromycin based triple therapy and 58.9% received a four-drug regimen. The overall effectiveness of first-line therapy was 85% and 86% by modified intention-to-treat and per protocol analyses, respectively. The effectiveness of both sequential and concomitant therapies was 100% while clarithromycin-based triple therapy achieved an eradication rate of 79%. Treatment eradication was higher among patients who received high dose proton pump inhibitor (PPI) compared to those treated with low dose PPI (100% vs. 81.5% respectively, P < 0.01). No difference in treatment effectiveness was found between 7-, 10-, and 14-day treatment. The effectiveness of clarithromycin-based triple therapy is suboptimal. First-line treatment of H. pylori infection should consist of four drugs, including high dose PPI, according to international guidelines.