S1348 Triple Therapy for Primary Treatment of Helicobacter pylori: A 19-Year U.S. Single Center Experience

Abstract

INTRODUCTION: Helicobacter pylori (H.pylori) is an important worldwide cause of peptic ulcer disease, gastric cancer and upper gastrointestinal symptoms. Triple therapy with a proton pump inhibitor, clarithromycin, and amoxicillin (PCA) or metronidazole (PCM) for 14 days remains the mainstay of first-line therapy for H. pylori infection in the US, however, there is evidence that antibiotic resistance, particularly to macrolides, is increasing in the United States (US). Aim: (i) Determine the effectiveness of PCA & PCM for eradicating H.pylori infection over the past 19 years (ii) Determine the impact of compliance on eradication rates with PCA & PCM. METHODS: A retrospective analysis was performed on all patients (pts) referred for a 13C urea breath test (UBT) following first line PCA or PCM therapy for H. pylori at a single US medical center between January 2001 – October 2019. Patients included in this analysis had H. pylori infection documented by gastric biopsy, UBT or fecal antigen test. All patients were treated with PCA or PCM for 10-14 days. Time frames for comparison included a cure rate over the entire 19-year study period and sub-divided into four 5-year blocks (2001-2005, 2006-2010, 2011-2015, and 2016-2019). Cure rates & 95% confidence intervals were calculated for PCA & PCM combined and each regimen separately. Logistic regression was conducted to determine if therapy compliance influenced H.pylori eradication. RESULTS: Data was analyzed on 1058 pts (mean age 51.1 (SD = 15.4; Range:18-90), 61.8% female, and 49.5% Caucasian). H.pylori eradications rates using PCA or PCM was 78.1%. PCA (79.1%) and PCM yielded similar eradication rates (79.1% vs. 77.8%, NS). Eradication rates for PCA & PCM divided into 5-year time blocks were similar [Table 1]. Therapy compliance did not significantly influence eradication rates. CONCLUSION: Real world eradication rates of PCA & PCM at a large midwestern US medical center have remained stable over almost 2 decades. The eradication rates of < 80% raise questions about whether these regimens deserve to be the preferred first-line therapies for H. pylori in the US.Table 1.: Cumulative Eradication Rates (2001-2019)Table 2.: Five Year Interval Eradication Rates