Treatment failure of Helicobacter Pylori in primary care

Gertrude van den Brink; Lieke M Koggel; Joris Jh Hendriks; Mark Gj de Boer; Peter D Siersema; Mattijs E Numans

doi:10.3399/BJGPO.2023.0252

Treatment failure of Helicobacter Pylori in primary care

BJGP Open. 2024 Mar 4:BJGPO.2023.0252. doi: 10.3399/BJGPO.2023.0252. Online ahead of print.

Authors

Gertrude van den Brink¹, Lieke M Koggel², Joris Jh Hendriks², Mark Gj de Boer³, Peter D Siersema^{2

4}, Mattijs E Numans⁵

Affiliations

¹ Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands g.van_den_brink@lumc.nl.
² Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud university medical centre, Nijmegen, Netherlands.
³ Department of infectious diseases & Department of Clinical Epidemiology Leiden University Medical Centre, Leiden University Centre for |Infectious Diseases, Leiden, Netherlands.
⁴ Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Centre, Rotterdam, Netherlands.
⁵ Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands.

PMID: 38438197
DOI: 10.3399/BJGPO.2023.0252

Abstract

Background: Due 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 health care data from 80 general practices in the Netherlands.

Method: Patients with ICPC-codes for gastric symptoms or ATC-code 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 one year following eradication therapy.

Results: We identified 138,455 patients with gastric symptoms and/or acid inhibition use (mean age 57 years [SD 18.2], 43% male). A total of 5,224 (4%) patients received a 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% CI 0.33-1.22). After successful eradication, 2,329/4,808 (48%) patients used acid inhibition compared to 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.

Keywords: Helicobacter pylori; primary health care; treatment failure.