S1606 A Retrospective Study of Doxycycline-Based Quadruple Therapy versus Tetracycline-Based Quadruple Therapy for the First Line Treatment of Helicobacter pylori

Abstract

Introduction: The global prevalence of antimicrobial resistance has resulted in challenges with H. pylori eradication. Gastric acid suppression and antibiotic therapy are used to eradicate H. pylori. Cost and shortages inhibit use of tetracycline for first line treatment of H. pylori. Doxycycline represents a possible cost-effective alternative for treating H. pylori. We performed an analysis of first line doxycycline-based quadruple therapy in comparison to tetracycline-based quadruple therapy in the eradication of H. pylori. Methods: A retrospective chart review was conducted using the Advocate Aurora Health database, a multi-hospital community-based system consisting of sixteen hospitals and over 500 sites of care. All patients age 18 and older with documented H. pylori infection treated with either a first line doxycycline-based regimen (DOX) or tetracycline-based regimen (TCN) from January 2012 to April 2022 were included. In total, 3,384 patients were identified. Patients who received prior first-line treatment with other regimens were excluded. All cases were reviewed for confirmation of infection (either by biopsy, breath test or stool antigen testing), the treatment regimen used, and confirmation of H. Pylori eradication (either by biopsy, breath test, or stool antigen). Patients without confirmation of eradication or with pending eradication test results were excluded. Patient demographics were summarized and eradication rates determined. Results: Of the 3,384 reviewed cases, 628 cases met inclusion and exclusion criteria. Of these, 305 patients were treated with DOX and 323 patients were treated with TCN. Based on these numbers, a posteriori non-inferiority calculation with an assumed 85% eradication rate for the TCN and 80% for DOX and 90% power suggested 100 patents were needed per group (HyLown Consulting LLC, Statistical Calculators). The average age for DOX was 57 years and 193/305 (60%) were female. The average age for TCN was 58.5 years and 210/323 (69%) were female. Eradication rates were 87.6% for DOX and 88.2% for TCN (Table). Conclusion: Doxycycline-based quadruple therapy regimen is effective and appears to be non-inferior to tetracycline-based quadruple therapy regimens for first line treatment of H. pylori. Table 1. - The number of patients with tetracycline or doxycycline antibiotic regimens and the eradication rate Doxycycline Regimen # of Patients % of Patients Successful Eradication 283 87.6% Failed Eradication 40 12.4% Total 323 Tetracycline Regimen # of Patients % of Patients Successful Eradication 269 88.2% Failed Eradication 36 11.8% Total 305