1223 7 Years' Retrospective Study of Helicobacter pylori Therapy Prescription Patterns in an Urban Academic Medical Center in the United States

Abstract

INTRODUCTION: H. pylori is a significant cause of gastrointestinal (GI) morbidity and highly associated with gastric cancer. Combined with rising antibiotic resistance rates, prescribing effective treatment is important. Infection is not only managed by gastroenterologists, so discrepancies in prescribing patterns between GI and non-GI practitioners would be expected. Despite new ACG guidelines recommending that clarithromycin triple therapy (Tx) is no longer first line, non-GI providers may still be prescribing it over more effective therapies. METHODS: The data of 808 H. pylori positive adult patients, treated a variety of regimens in an urban academic medical center in the United States from 2011 to 2017 was collected and stratified by year. Positivity was determined by urea breath test, serology, stool antigen testing, or pathology. Therapies were categorized by departments, either GI (GI, pediatrics GI, hepatology, or digestive diseases) or non-GI related. Microsoft Excel was used for statistical analysis. T-tests significance level was set to α = 0.05. RESULTS: GI providers (68.4%) prescribed 660 therapies (315 triple, 208 quadruple, 33 sequential, 52 concomitant, & 52 hybrid). Non-GI providers (31.6%) prescribed 286 therapies (226 triple, 39 quadruple, 5 sequential, 4 concomitant, & 12 hybrid). Overall, significant differences were seen in triple (-31.3%), quadruple (17.9%), sequential (3.3%), concomitant (6.5%), and hybrid (3.7%) Tx between the groups. Significant differences between them in triple and quadruple Tx were seen in 2012-2017 and 2012 & 2014-2017, respectively. Differences in sequential, concomitant, and hybrid Tx were significant in 2015 & 2017, 2016-2017, and 2011 & 2013 & 2015, respectively. Amongst GI prescribers, a significant increase (27.9%) in concomitant Tx from 2016 to 2017 and decrease in triple Tx (15.1%) from 2015 to 2016 was observed. After 2016, triple Tx was exceeded by quadruple and concomitant Tx in the GI group, but remained the most prescribed in non-GI group. CONCLUSION: Triple therapy most likely decreased due to new guidelines, but it remains most prescribed by non-GI practitioners, suggesting more resources should be invested in outreach. Consistent decrease of triple therapy in the GI group, juxtaposed to the non-GI group, strongly reinforces the guideline's impact on prescription patterns. Thus, further studies to determine changes in non-GI prescribing patterns would be warranted.