Treatment failure of Helicobacter pylori in primary care: a retrospective cohort study.

Autor:	van den Brink G; Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands g.van_den_brink@lumc.nl., Koggel LM; Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands., Hendriks JJ; Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands., de Boer MG; Department of Infectious Diseases & Department of Clinical Epidemiology Leiden University Medical Centre, Leiden University Centre for Infectious Diseases, Leiden, the Netherlands., Siersema PD; Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands.; Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, the Netherlands., Numans ME; Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.
Jazyk:	angličtina
Zdroj:	BJGP open [BJGP Open] 2024 Oct 29; Vol. 8 (3). Date of Electronic Publication: 2024 Oct 29 (Print Publication: 2024).
DOI:	10.3399/BJGPO.2023.0252
Abstrakt:	Background: Owing to increasing antibiotic resistance, the worldwide efficacy of Helicobacter pylori (HP) eradication treatment has decreased. Aim: To determine antimicrobial resistance of HP in primary care. Design & Setting: Retrospective cohort study using real-world routine healthcare data from 80 general practices in the Netherlands. Method: Patients with International Classification of Primary Care (ICPC) codes for gastric symptoms or Anatomical Therapeutic Chemical (ATC) codes for acid inhibition in the period 2010-2020 were selected. Main outcomes were antimicrobial resistance of HP, defined as the prescription of a second eradication treatment within 12 months, and clinical remission of gastric symptoms, defined as no usage of acid inhibition 1 year following eradication therapy. Results: We identified 138 455 patients with gastric symptoms and/or acid inhibition use (mean age 57 years [standard deviation 18.2 years], 43% male). A total of 5224 (4%) patients received an HP eradication treatment. A second treatment was prescribed to 416 (8%) of those patients. From these, 380 patients received amoxicillin-clarithromycin, 16 amoxicillin-metronidazole, and 11 clarithromycin-metronidazole as first regimen and were considered antimicrobial resistant. We observed a 0.8% increment per year of patients requiring a second eradication treatment ( P = 0.003, 95% confidence interval = 0.33 to 1.22). After successful eradication, 2329/4808 (48%) patients used acid inhibition compared with 355/416 (85%) patients following treatment failure ( P <0.001). Conclusion: Antimicrobial treatment is not successful in almost one-tenth of HP infections in primary care after a first treatment containing clarithromycin and/or metronidazole. Although the treatment failure rate is not as high as reported in secondary care, the increasing trend is concerning and may require revision of the current guidelines. (Copyright © 2024, The Authors.)
Databáze:	MEDLINE
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