Clarithromycin for H pylori more likely to fail in macrolide-exposed patients

  • Helicobacter

  • Jenny Blair, MD
  • Clinical Essentials
L'accesso ai contenuti di questo sito è riservato agli operatori del settore sanitario italiano L'accesso ai contenuti di questo sito è riservato agli operatori del settore sanitario italiano

Takeaway

  • Treatment with a macrolide, even years earlier, may predict Helicobacter pylori treatment failure with clarithromycin-containing regimens.
  • Prospective studies are needed in multiple geographic regions.

Why this matters

  • H pylori resistance to clarithromycin is rising.
  • Few data exist on the relationship between prior use of antibiotics and H pylori eradication failure.

Study design

  • Retrospective cohort study of 212 prospectively recruited Spanish patients with H pylori infection between 2014 and 2016.
  • Participants took 1 of 2 clarithromycin-containing eradication regimens: triple or concomitant quadruple therapy.
  • Researchers assessed eradication success or failure and checked medical records for prescriptions for macrolides, amoxicillin, metronidazole, or quinolones since 2004.
  • Funding: None.

Key results

  • 47.2% patients had previously been prescribed macrolides (mean, 2.15 treatments).
  • Previous macrolide prescription correlated with lower eradication rates:
    • On univariate analysis, 73/100 exposed patients (73%) had successful eradication vs 107/112 unexposed patients (95.5%) (P<.0001>
    • On multivariate analysis: OR, 0.13 (P<.0001>
  • Lower eradication rate in macrolide-exposed vs unexposed patients held true for both eradication regimens (triple therapy: 60.8% vs 92.9% [P<.0001 respectively concomitant quadruple therapy: vs>
  • Exposure to other antibiotics was not associated with significant difference in eradication rates.

Limitations

  • Prescriptions used as proxy for intake.
  • Generalizability outside Spain is unclear.