Bismuth quadruple regimen with tetracycline or doxycycline versus three‐in‐one single capsule as third‐line rescue therapy for Helicobacter pylori infection: Spanish data of the European Helicobacter pylori Registry (Hp‐EuReg)

• DOI: 10.1111/hel.12722
• Publication Date: 2020-07-13T07:39:55Z
• Authors: Olga P. Nyssen; Angeles Perez‐Aisa; Luis Rodrigo; Manuel Castro; Pilar Mata Romero; Juan Ortuño; Jesus Barrio; Jose Maria Huguet; Ines Modollel; Noelia Alcaide; Alfredo Lucendo; Xavier Calvet; Monica Perona; Barbara Gomez; Blas Jose Gomez R...; Pilar Varela; Manuel Jimenez‐Mo...; Manuel Dominguez‐...; Liliana Pozzati; Diego Burgos‐Sant...; Luis Bujanda; Jenifer Hinojosa; Javier Molina‐Inf...; Tommaso Di Maira; Luis Ferrer; Luis Fernández‐Sa...; Ariadna Figuerola; Llucia Tito; Cristobal de la Coba; Judith Gomez‐Cama...; Nuria Fernandez; Maria Caldas; Ana Garre; Elena Resina; Ignasi Puig; Colm O’Morain; Francis Megraud; Javier P. Gisbert
• Keywords: Regimen

Abstract Background Different bismuth quadruple therapies containing proton‐pump inhibitors, salts, metronidazole, and a tetracycline have been recommended as third‐line Helicobacter pylori eradication treatment after failure with clarithromycin levofloxacin. Aim To evaluate the efficacy safety of treatments bismuth, either or doxycycline. Methods Sub‐study Spanish data “European Registry on H Management” (Hp‐EuReg), international multicenter prospective non‐interventional routine clinical practice gastroenterologists. After previous clarithromycin‐ levofloxacin‐containing therapies, patients receiving regimen 10/14‐day (BQT‐Tet) doxycycline (BQT‐Dox), single capsule (BQT‐three‐in‐one) were included. Data registered at AEG‐REDCap database. Univariate multivariate analyses performed. Results Four‐hundred fifty‐four treated so far: 85 BQT‐Tet, 94 BQT‐Dox, 275 BQT‐three‐in‐one. Average age was 53 years, 68% women. Overall modified intention‐to‐treat per‐protocol rates 81% (BQT‐Dox: 65%, BQT‐Tet: 76%, BQT‐three‐in‐one: 88%) 82% 66%, 77%, 88%), respectively. By logistic regression, higher associated compliance (OR = 2.96; 95% CI 1.01‐8.84) no prior metronidazole use 1.96; 1.15‐3.33); BQT‐three‐in‐one superior to BQT‐Dox 4.46; 2.51‐8.27), BQT‐Tet marginally 1.67; 0.85‐3.29). Conclusion Third‐line (after levofloxacin) offers acceptable safety. Highest found in compliant those taking 10‐day 14‐day BQT‐Tet. Doxycycline seems be less effective therefore should not recommended.