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European Registry on Helicobacter pylori Management: Effectiveness of First and Second-Line Treatment in Spain.

María CaldasÁngeles Pérez-AisaManuel Castro-FernándezLuis BujandaAlfredo J LucendoLuis RodrigoJose M HuguetJorge Pérez-LasalaJavier Molina-InfanteJesús BarrioLuis Fernández-SalazarAngel LanasMónica PeronaManuel Domínguez-CajalJuan OrtuñoBlas José Gómez RodríguezPedro AlmelaJosep María BotarguésÓscar NúñezInés ModolellJudith GómezRafael Ruiz-ZorrillaCristóbal De la CobaAlain HuertaEduardo IyoLiliana PozzatiRosario AntónMercé BarenysTeresa AngueiraMiguel Fernández-BermejoAna CampilloJavier AlcedoRamón Pajares-VillaroyaMarianela MegoFernando BermejoJosé Luis Dominguez-JiménezLlúcia TitóNuria FernándezManuel Pabón CarrascoÁngel CosmePilar Mata-RomeroNoelia AlcaideInés AriñoTommaso Di MairaAna GarreIgnasi PuigOlga P NyssenFrancis MégraudColm O'MorainFrancisco Javier García-Alonsonull null
Published in: Antibiotics (Basel, Switzerland) (2020)
The management of Helicobacter pylori infection has to rely on previous local effectiveness due to the geographical variability of antibiotic resistance. The aim of this study was to evaluate the effectiveness of first and second-line H. pylori treatment in Spain, where the empirical prescription is recommended. A multicentre prospective non-interventional registry of the clinical practice of European gastroenterologists concerning H. pylori infection (Hp-EuReg) was developed, including patients from 2013 until June 2019. Effectiveness was evaluated descriptively and through a multivariate analysis concerning age, gender, presence of ulcer, proton-pump inhibitor (PPI) dose, therapy duration and compliance. Overall, 53 Spanish hospitals were included, and 10,267 patients received a first-line therapy. The best results were obtained with the 10-day bismuth single-capsule therapy (95% cure rate by intention-to-treat) and with both the 14-day bismuth-clarithromycin quadruple (PPI-bismuth-clarithromycin-amoxicillin, 91%) and the 14-day non-bismuth quadruple concomitant (PPI-clarithromycin-amoxicillin-metronidazole, 92%) therapies. Second-line therapies were prescribed to 2448 patients, with most-effective therapies being the triple quinolone (PPI-amoxicillin-levofloxacin/moxifloxacin) and the bismuth-levofloxacin quadruple schemes (PPI-bismuth-levofloxacin-amoxicillin) prescribed for 14 days (92%, 89% and 90% effectiveness, respectively), and the bismuth single-capsule (10 days, 88.5%). Compliance, longer duration and higher acid inhibition were associated with higher effectiveness. "Optimized" H. pylori therapies achieve over 90% success in Spain.
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