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Retrospective Analysis Confirms Tetracycline Quadruple as Best Helicobacter pylori Regimen in the USA

  • Mohd Amer Alsamman
  • Eric C. Vecchio
  • Khaled Shawwa
  • Gabriel Acosta-Gonzales
  • Murray B. Resnick
  • Steven F. MossEmail author
Original Article
  • 35 Downloads

Abstract

Background

Declining Helicobacter pylori (H. pylori) eradication rates have prompted a switch in first-line therapy from standard triple (PPI, clarithromycin, and amoxicillin) to bismuth-based quadruple therapy. A caveat of the ACG 2017 H. pylori treatment guidelines was a paucity of recent US eradication data.

Aim

To determine Rhode Island H. pylori eradication data, in the largest US study from the last two decades.

Methods

Electronic records were queried for patients with H. pylori infection diagnosed by pathology, urea breath test, or stool antigen from 2015 to 2017. Demographics, diagnostic test, treatment regimen, and test of cure were extracted. Eradication rates were calculated, and treatment regimens were compared.

Results

A total of 1710 patients were identified (64% female): 825 (46%) diagnosed by breath test, 755 (42%) by biopsy, and 191 (12%) by stool antigen. Full data were obtained on 1101 patients. Seven regimens were used: quadruple (64%), triple (25%), doxycycline quadruple (5%), and miscellaneous (6%). Quadruple was superior to triple: (85% vs. 75%, P = 0.002), quadruple 14 days versus triple 14 days (87% vs. 79%, P = 0.0052), quadruple 10 days versus triple 10 days (77% vs. 67%, P = 0.33). Increased therapy length improved eradication (quadruple 14 days  vs. 10 days, 87% vs. 77%, P = 0.002; triple 14 days  versus 10 days 79% vs. 67%, P = 0.13). Finally, substituting doxycycline for tetracycline yielded lower eradication (85% vs. 67%, P = 0.006).

Conclusion

Quadruple therapy is superior to triple therapy within the Rhode Island population. Fourteen-day therapy achieves superior eradication compared to 10-day therapy, and doxycycline is inferior to tetracycline for quadruple therapy. Our findings support adherence to ACG and international guidelines advising 14-day quadruple therapy.

Keywords

Helicobacter pylori Stomach USA Gastrointestinal infections Eradication therapy 

Abbreviations

ACG

American College of Gastroenterology

PPI

Proton pump inhibitor

TOC

Test of cure

UBT

Urea breath test

Notes

Author’s contribution

All authors contributed substantially to the manuscript. Dr. SFM conceived and supervised the study and Drs. MAA and SFM wrote the IRB proposal. Dr. MAA, Dr. ECV and Dr. GA-G performed chart review and data collection. Dr. KS and Dr. MAA performed all statistical analysis with input from Dr. SFM., Dr. MAA, and Dr. ECV wrote the initial draft of the manuscript with critical input from Dr. SFM and all other listed authors. Each author read and approved the final manuscript.

Compliance with Ethical Standards

Conflict of interest

Dr Moss receives grant support from American Molecular Laboratories for an unrelated clinical study. There were no other financial, professional, or personal conflicts of interests to declare on behalf of all authors.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Hospital Medicine, The Miriam HospitalThe Warren Alpert Medical School of Brown UniversityProvidenceUSA
  2. 2.Internal Medicine, Rhode Island HospitalThe Warren Alpert Medical School of Brown UniversityProvidenceUSA
  3. 3.Division of Nephrology and HypertensionMayo ClinicRochesterUSA
  4. 4.Department of Pathology, Rhode Island HospitalThe Warren Alpert Medical School of Brown UniversityProvidenceUSA
  5. 5.Division of Gastroenterology, Rhode Island HospitalThe Warren Alpert Medical School of Brown UniversityProvidenceUSA

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