Outcome of treatment for Helicobacter pylori infection in the carinthian region
Keywords:
Helicobacter pylori, antimicrobial therapy, eradication rate, antimicrobial resistanceAbstract
Backgrounds: Antimicrobial resistance is the major cause for treatment failure in Helicobacter pylori(HP) infection. In the majority of countries, including Slovenia, the eradication rate of primary therapy is below 80 %. So far we have not have any data about HP infection treatment in Carinthian region.
Methods: We performed a retrospective analysis of medical documentation of all patients treated in our institution for HP infection in 2011 and 2012. Treatment outcome was determined by urea breath test. Basic demographic data of patients, endoscopic findings and histologic diagnosis were analysed together with the treatment regimen chosen and the eradication rates achieved. Secondary resistance rates for anti- microbials were calculated in patients that had culture and sensitivity tests performed because of treatment failure.
Results: Total of 324 patients were included in the analysis (60.2 % female and 39.8 % male, mean age 52.1 years): 111 patients in the year 2011 (52.3 % female and 47.7 % male, mean age 53.0 years) and 213 (64.3 % female and 35.7 % male, mean age 54.1 years); 90.0 % (n = 285) of patients had endoscopic findings of chronic active gastritis, 3.1 % (n = 10) of patients had peptic ulcer disease; 27.8 % (n = 90) of patients had pre-cancerous lesions of gastric mucosa (atrophy or intestinal metaplasia) present on histology.
Seven-day triple therapy with a proton pump inhibitor (PPI), amoxicillin and clarithromycin (PAC) was prescribed in 87.7 % (n = 284) of patients as the first line treatment option, 11.7 % (n = 38) of patient received 7-day triple therapy with PPI, amoxicillin and metronidazole (PAM) and 0.6 % (n = 2) of patients received 7-day triple therapy with PPI, clarithromycin and metronidazole (PCM). The eradication rate with the firstline therapy was 70.7 % intention to treat (ITT) analysis and 70.9 % per protocol (PP) analysis. Cumulative eradication rate for up to four lines of therapy was 89.9 % ITT analysis and 99.7 % PP analysis. Culture and sensitivity tests were performed in 16.4 % (n = 53) of patients. Secondary resistance rates for clarithromycin, metronidazole, levofloxacin, amoxicillin and tetracycline in patients after treatment failure were 84.6 %, 70.0 %, 7.7 %, 2.5 % and 0.0 %, respectively.
Conclusions: The analysis of HP treatment in the Carinthian region in the period between 2011 and 2012 is presented. The success rate of the first-line therapy is at a critically low level. Cumulative eradication rate in the ITT analysis has dropped below 90 %. However, it is still high in the PP analysis, but on the account of longer treatment and higher costs. An optimization of the initial treatment strategies for the HP eradication is needed. Systematic surveillance of antimicrobial resistance of HP in our region as well as in other regions of Slovenia is mandatory.
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