Abstract
BackgroundEradicating Helicobacter pylori infection is clinically challenging, notably in cases with penicillin allergy. Cephalosporin could be used in lieu of amoxicillin to eradicate Helicobacter pylori. The current work aimed to assess therapeutic efficacy and safety of a cefuroxime-based quadruple regimen in treatment-naïve individuals with penicillin allergy, as well as patient compliance.MethodsIn the present prospective single-center cohort study, 152 Helicobacter pylori infected individuals with penicillin allergy received eradication therapy with cefuroxime (500 mg twice/day), levofloxacin (500 mg once/day), esomeprazole (20 mg twice/day) and bismuth potassium citrate (220 mg twice/day; 14 days). Safety and compliance were evaluated 1 to 3 days upon eradication. The urea breath test was carried out 8 to 12 weeks upon eradication for efficacy assessment.ResultsThis quadruple antimicrobial regimen eradicated the pathogen at 85.5% (95% confidence interval (CI) 79.6–90.8%), 88.4% (95% CI 83.0–93.2%) and 90.1% (95% CI 85.2–94.4%) in intention-to-treat, modified intention-to-treat and per-protocol analyses, respectively, with resistance rates of 4.6 and 40.0% in the background of cefuroxime and levofloxacin, respectively. Meanwhile, 21.3% of patients had adverse reactions, but none was serious. A total of 95.3% of patients showed good compliance. Poor compliance and cefuroxime resistance were detected by uni- or multivariate analyses as independent factors predicting therapeutic failure. Eradication rates in patients with dual levofloxacin and cefuroxime susceptibility, isolated levofloxacin resistance, isolated cefuroxime resistance and dual resistance were 97.2, 84.0, 50.0, and 0%, respectively (P = 0.002).ConclusionsCefuroxime, levofloxacin, esomeprazole, and bismuth achieved decent efficacy, safety and compliance as first-line antimicrobial regimen in patients with Helicobacter pylori and penicillin allergy.
Highlights
Eradicating Helicobacter pylori infection is clinically challenging, notably in cases with penicillin allergy
The limited data from a few clinical studies demonstrated that cephalosporin-containing regimens achieve relatively satisfactory eradication rates [20, 22, 23]. .These findings suggested that cephalosporin has a high potential for H. pylori treatment
This work primarily aimed to assess the eradication efficacy of cefuroxime, levofloxacin, esomeprazole, and bismuth (CLEB) regimen in patients infected by H. pylori with penicillin allergy
Summary
Eradicating Helicobacter pylori infection is clinically challenging, notably in cases with penicillin allergy. The current work aimed to assess therapeutic efficacy and safety of a cefuroxime-based quadruple regimen in treatment-naïve individuals with penicillin allergy, as well as patient compliance. Helicobacter pylori (H. pylori) infection and associated diseases are important global health problems. Eradication therapy is important in treating and preventing H. pylori infection-related diseases [1]. Because of generally increased resistance to clarithromycin and metronidazole, PPI-clarithromycin-metronidazole therapy achieves unsatisfactory cure rates in most regions of the world [9,10,11,12]. Due to a number of shortcomings (e.g., complicated administration, common adverse reactions, and tetracycline unavailability in many regions), the clinical application of bismuth quadruple therapy has been restricted [13,14,15]. For penicillin-allergic patients, safe, effective and accessible regimens for H. pylori eradication are still lacking
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
