Helicobacter pylori first-line and rescue treatments in
patients allergic to penicillin: Experience from the European
Registry on H pylori management (Hp-EuReg)

NYSSEN, O. P., A. PEREZ-AISA, B. TEPES, L. RODRIGO-SAEZ, P. M. ROMERO, A. LUCENDO, M. CASTRO-FERNANDEZ, P. PHULL, J. BARRIO, L. BUJANDA, J. ORTUNO, M. AREIA, N. B. JURECIC, J. M. HUGUET, N. ALCAIDE, I. VOYNOVAN, J. M. B. BOTE, I. MODOLELL, J. P. LASALA, I. ARINO, L. JONAITIS, M. DOMINGUEZ-CAJAL, G. BUZAS, F. LERANG, M. PERONA, D. BORDIN, T. AXON, A. GASBARRINI, R. M. PINTO, Y. NIV, L. KUPCINSKAS, A. TONKIC, M. LEJA, T. ROKKAS, L. BOYANOVA, O. SHVETS, M. VENERITO, P. BYTZER, A. GOLDIS, I. SIMSEK, V. LAMY, K. PRZYTULSKI, Lumír KUNOVSKÝ, L. CAPELLE, T. MILOSAVLJEVIC, M. CALDAS, A. GARRE, F. MEGRAUD, C. O'MORAIN and J. P. GISBERT. Helicobacter pylori first-line and rescue treatments in patients allergic to penicillin: Experience from the European Registry on H pylori management (Hp-EuReg). Helicobacter. HOBOKEN: WILEY, 2020, vol. 25, No 3, p. 1-11. ISSN 1083-4389. Available from: https://dx.doi.org/10.1111/hel.12686.

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TY  - JOUR
ID  - 1655056
AU  - Nyssen, O. P. - Perez-Aisa, A. - Tepes, B. - Rodrigo-Saez, L. - Romero, P. M. - Lucendo, A. - Castro-Fernandez, M. - Phull, P. - Barrio, J. - Bujanda, L. - Ortuno, J. - Areia, M. - Jurecic, N. B. - Huguet, J. M. - Alcaide, N. - Voynovan, I. - Bote, J. M. B. - Modolell, I. - Lasala, J. P. - Arino, I. - Jonaitis, L. - Dominguez-Cajal, M. - Buzas, G. - Lerang, F. - Perona, M. - Bordin, D. - Axon, T. - Gasbarrini, A. - Pinto, R. M. - Niv, Y. - Kupcinskas, L. - Tonkic, A. - Leja, M. - Rokkas, T. - Boyanova, L. - Shvets, O. - Venerito, M. - Bytzer, P. - Goldis, A. - Simsek, I. - Lamy, V. - Przytulski, K. - Kunovský, Lumír - Capelle, L. - Milosavljevic, T. - Caldas, M. - Garre, A. - Megraud, F. - O'Morain, C. - Gisbert, J. P.
PY  - 2020
TI  - Helicobacter pylori first-line and rescue treatments in patients allergic to penicillin: Experience from the European Registry on H pylori management (Hp-EuReg)
JF  - Helicobacter
VL  - 25
IS  - 3
SP  - 1-11
EP  - 1-11
PB  - WILEY
SN  - 10834389
KW  - allergic
KW  - allergy
KW  - bismuth
KW  - clarithromycin
KW  - Helicobacter pylori
KW  - levofloxacin
KW  - penicillin
UR  - https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/hel.12686
L2  - https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/hel.12686
N2  - Background Experience in Helicobacter pylori eradication treatment of patients allergic to penicillin is very scarce. A triple combination with a PPI, clarithromycin (C), and metronidazole (M) is often prescribed as the first option, although more recently the use of a quadruple therapy with PPI, bismuth (B), tetracycline (T), and M has been recommended. Aim To evaluate the efficacy and safety of first-line and rescue treatments in patients allergic to penicillin in the "European Registry of H pylori management" (Hp-EuReg). Methods A systematic prospective registry of the clinical practice of European gastroenterologists (27 countries, 300 investigators) on the management of H pylori infection. An e-CRF was created on AEG-REDCap. Patients with penicillin allergy were analyzed until June 2019. Results One-thousand eighty-four patients allergic to penicillin were analyzed. The most frequently prescribed first-line treatments were as follows: PPI + C + M (n = 285) and PPI + B + T + M (classic or Pylera(R); n = 250). In first line, the efficacy of PPI + C + M was 69%, while PPI + B + T + M reached 91% (P < .001). In second line, after the failure of PPI + C + M, two rescue options showed similar efficacy: PPI + B + T + M (78%) and PPI + C + levofloxacin (L) (71%) (P > .05). In third line, after the failure of PPI + C + M and PPI + C + L, PPI + B + T + M was successful in 75% of cases. Conclusion In patients allergic to penicillin, a triple combination with PPI + C + M should not be generally recommended as a first-line treatment, while a quadruple regimen with PPI + B + T + M seems to be a better option. As a rescue treatment, this quadruple regimen (if not previously prescribed) or a triple regimen with PPI + C + L could be used but achieved suboptimal (<80%) results.
ER  -

Basic information
Original name	Helicobacter pylori first-line and rescue treatments in patients allergic to penicillin: Experience from the European Registry on H pylori management (Hp-EuReg)
Authors	NYSSEN, O. P. (724 Spain), A. PEREZ-AISA (724 Spain), B. TEPES (705 Slovenia), L. RODRIGO-SAEZ (724 Spain), P. M. ROMERO (724 Spain), A. LUCENDO (724 Spain), M. CASTRO-FERNANDEZ (724 Spain), P. PHULL (826 United Kingdom of Great Britain and Northern Ireland), J. BARRIO (724 Spain), L. BUJANDA (724 Spain), J. ORTUNO (724 Spain), M. AREIA (620 Portugal), N. B. JURECIC (705 Slovenia), J. M. HUGUET (724 Spain), N. ALCAIDE (724 Spain), I. VOYNOVAN (643 Russian Federation), J. M. B. BOTE (724 Spain), I. MODOLELL (724 Spain), J. P. LASALA (724 Spain), I. ARINO (724 Spain), L. JONAITIS (440 Lithuania), M. DOMINGUEZ-CAJAL (724 Spain), G. BUZAS (348 Hungary), F. LERANG (578 Norway), M. PERONA (724 Spain), D. BORDIN (643 Russian Federation), T. AXON (826 United Kingdom of Great Britain and Northern Ireland), A. GASBARRINI (380 Italy), R. M. PINTO (620 Portugal), Y. NIV (376 Israel), L. KUPCINSKAS (440 Lithuania), A. TONKIC (191 Croatia), M. LEJA (428 Latvia), T. ROKKAS (100 Bulgaria), L. BOYANOVA (804 Ukraine), O. SHVETS (804 Ukraine), M. VENERITO (276 Germany), P. BYTZER (208 Denmark), A. GOLDIS (642 Romania), I. SIMSEK (792 Turkey), V. LAMY (56 Belgium), K. PRZYTULSKI (616 Poland), Lumír KUNOVSKÝ (203 Czech Republic, belonging to the institution), L. CAPELLE (528 Netherlands), T. MILOSAVLJEVIC (688 Serbia), M. CALDAS (724 Spain), A. GARRE (724 Spain), F. MEGRAUD (250 France), C. O'MORAIN (372 Ireland) and J. P. GISBERT (724 Spain, guarantor).
Edition	Helicobacter, HOBOKEN, WILEY, 2020, 1083-4389.

Other information
Original language	English
Type of outcome	Article in a journal
Field of Study	30219 Gastroenterology and hepatology
Country of publisher	United States of America
Confidentiality degree	is not subject to a state or trade secret
WWW	URL
Impact factor	Impact factor: 5.753
RIV identification code	RIV/00216224:14110/20:00115632
Organization unit	Faculty of Medicine
Doi	http://dx.doi.org/10.1111/hel.12686
UT WoS	000531884500002
Keywords in English	allergic; allergy; bismuth; clarithromycin; Helicobacter pylori; levofloxacin; penicillin
Tags	14110213, 14110223, rivok
Tags	International impact, Reviewed
Changed by	Changed by: Mgr. Tereza Miškechová, učo 341652. Changed: 5/8/2020 10:17.

Abstract

Background Experience in Helicobacter pylori eradication treatment of patients allergic to penicillin is very scarce. A triple combination with a PPI, clarithromycin (C), and metronidazole (M) is often prescribed as the first option, although more recently the use of a quadruple therapy with PPI, bismuth (B), tetracycline (T), and M has been recommended. Aim To evaluate the efficacy and safety of first-line and rescue treatments in patients allergic to penicillin in the "European Registry of H pylori management" (Hp-EuReg). Methods A systematic prospective registry of the clinical practice of European gastroenterologists (27 countries, 300 investigators) on the management of H pylori infection. An e-CRF was created on AEG-REDCap. Patients with penicillin allergy were analyzed until June 2019. Results One-thousand eighty-four patients allergic to penicillin were analyzed. The most frequently prescribed first-line treatments were as follows: PPI + C + M (n = 285) and PPI + B + T + M (classic or Pylera(R); n = 250). In first line, the efficacy of PPI + C + M was 69%, while PPI + B + T + M reached 91% (P < .001). In second line, after the failure of PPI + C + M, two rescue options showed similar efficacy: PPI + B + T + M (78%) and PPI + C + levofloxacin (L) (71%) (P > .05). In third line, after the failure of PPI + C + M and PPI + C + L, PPI + B + T + M was successful in 75% of cases. Conclusion In patients allergic to penicillin, a triple combination with PPI + C + M should not be generally recommended as a first-line treatment, while a quadruple regimen with PPI + B + T + M seems to be a better option. As a rescue treatment, this quadruple regimen (if not previously prescribed) or a triple regimen with PPI + C + L could be used but achieved suboptimal (<80%) results.

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