1214 Quadruple Therapy Is Superior to Triple Therapy in the Treatment of Clarithromycin Exposed Helicobacter pylori

Abstract

INTRODUCTION: Resistance of Helicobacter Pylori to antibiotics has reached alarming levels around the world, which has a great effect on efficacy of treatment. Little is known about its resistance pattern and optimal treatment within Brooklyn, New York. The objective of this study was to investigate whether triple or quadruple therapy is more effective in the treatment of H. Pylori, and whether prior clarithromycin exposure affects primary clinical outcomes. METHODS: A total of 598 patients were identified by retrospective chart review from January 2015 to January 2018 that satisfied our inclusion criteria; 272 of those patients were selected based on selection criteria. Patients were excluded from the study if they were less than 18 years of age, or were treated for recurrent H. Pylori infection. Descriptive statistics was used to compare continuous and categorical variables. RESULTS: Of the 272 patients identified, the median age was 50 ± 16 years. The majority (36%) of patients were Asian. Approximately 20.5% of patients were active smokers or had a history of smoking. 84% (n = 229) patients did not have prior clarithromycin exposure, while only 16% (n = 43) were exposed. 65% (n = 176) patients used triple therapy, while 35% (n = 96) used quadruple therapy for H. Pylori treatment. 79% (n = 214) patients had no recurrence, while 21% (n = 58) patients experienced treatment failure. Overall, triple therapy was associated with higher rates of treatment failure when compared to quadruple therapy (22% triple therapy vs 20% quadruple therapy). When prior clarithromycin exposure taken into account, treatment failure increased to about 28%. This effect was higher in patients treated with triple therapy than quadruple (28% vs 27%, respectively). However, due to small sample sizes, significance was not observed. CONCLUSION: Quadruple therapy appears to be more effective at treating H. Pylori overall and in the setting of prior clarithromycin exposure. While these findings may guide clinical decision making, larger head to head studies are needed to validate these findings.