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Helicobacter Pylori First-Line and Rescue Treatments in the Presence of Penicillin Allergy

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Abstract

Background

Helicobacter pylori eradication is a challenge in penicillin allergy.

Aim

To assess the efficacy and safety of first-line and rescue treatments in patients allergic to penicillin.

Methods

Prospective multicenter study. Patients allergic to penicillin were given a first-line treatment comprising (a) 7-day omeprazole–clarithromycin–metronidazole and (b) 10-day omeprazole–bismuth–tetracycline–metronidazole. Rescue treatments were as follows: (a) bismuth quadruple therapy; (b) 10-day PPI–clarithromycin–levofloxacin; and (c) 10-day PPI–clarithromycin–rifabutin. Eradication was confirmed by 13C-urea breath test. Compliance was determined through questioning and recovery of empty medication envelopes. Adverse effects were evaluated by questionnaires.

Results

In total, 267 consecutive treatments were included. (1) First-line treatment: Per-protocol and intention-to-treat eradication rates with omeprazole–clarithromycin–metronidazole were 59 % (62/105; 95 % CI 49–62 %) and 57 % (64/112; 95 % CI 47–67 %). Respective figures for PPI–bismuth–tetracycline–metronidazole were 75 % (37/49; 95 % CI 62–89 %) and 74 % (37/50; 95 % CI (61–87 %) (p < 0.05). Compliance with treatment was 94 and 98 %, respectively. Adverse events were reported in 14 % with both regimens (all mild). (2) Second-line treatment: Intention-to-treat eradication rate with omeprazole–clarithromycin–levofloxacin was 64 % both after triple and quadruple failure; compliance was 88–100 %, with 23–29 % adverse effects (all mild). (3) Third-/fourth-line treatment: Intention-to-treat eradication rate with PPI–clarithromycin–rifabutin was 22 %.

Conclusion

In allergic to penicillin patients, a first-line treatment with a bismuth-containing quadruple therapy (PPI–bismuth–tetracycline–metronidazole) seems to be a better option than the triple PPI–clarithromycin–metronidazole regimen. A levofloxacin-based regimen (together with a PPI and clarithromycin) represents a second-line rescue option in the presence of penicillin allergy.

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Abbreviations

H. pylori :

Helicobacter pylori

PPI:

Proton pump inhibitor

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Authors and Affiliations

  1. Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Playa de Mojácar 29. Urb. Bonanza, 28669, Boadilla del Monte, Madrid, Spain

    Javier P. Gisbert, Jose Luis Gisbert, Santiago Marcos, Alicia C. Marín & Adrián G. McNicholl

  2. Gastroenterology Department, Hospital Rio Hortega, Valladolid, Spain

    Jesús Barrio

  3. Gastroenterology Department, Consorci Sanitari de Terrassa, Barcelona, Spain

    Inés Modolell

  4. Gastroenterology Department, Hospital San Pedro de Alcántara, Cáceres, Spain

    Javier Molina-Infante & Miguel Fernández-Bermejo

  5. Gastroenterology Department, Agencia Sanitaria Costa del Sol, Málaga, Spain

    Angeles Perez Aisa

  6. Gastroenterology Department, Hospital de Valme and CIBEREHD, Seville, Spain

    Manuel Castro-Fernández

  7. Gastroenterology Department, Hospital Central de Asturias, Oviedo, Spain

    Luis Rodrigo

  8. Gastroenterology Department, Hospital de Donostia and CIBEREHD, San Sebastián, Spain

    Angel Cosme

Authors
  1. Javier P. Gisbert
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  2. Jesús Barrio
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  3. Inés Modolell
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  4. Javier Molina-Infante
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  5. Angeles Perez Aisa
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  6. Manuel Castro-Fernández
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  7. Luis Rodrigo
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  8. Angel Cosme
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  9. Jose Luis Gisbert
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  10. Miguel Fernández-Bermejo
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  11. Santiago Marcos
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  12. Alicia C. Marín
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  13. Adrián G. McNicholl
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Corresponding author

Correspondence to Javier P. Gisbert.

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Gisbert, J.P., Barrio, J., Modolell, I. et al. Helicobacter Pylori First-Line and Rescue Treatments in the Presence of Penicillin Allergy. Dig Dis Sci 60, 458–464 (2015). https://doi.org/10.1007/s10620-014-3365-2

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  • DOI: https://doi.org/10.1007/s10620-014-3365-2

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