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Catarina Correia, Nuno Almeida, Carina Leal, Diogo Branquinho, Alexandra Fernandes, Carlos Calhau,Isabel Bastos, Luis Tome and Helena Vasconcelos
Centro Hospitalar de Leiria, Portugal Centro Hospitalar e Universitario de Coimbra, Portugal Faculdade de Medicina Da Universidade de Coimbra, Portugal Centro Hospitalar do Baixo Vouga, Portugal
ScientificTracks Abstracts: J Clin Microbiol Infect Dis
Introduction: Helicobacter pylori (H. pylori) infection is highly prevalent in Portugal and its eradication is formally recommended in multiple circumstances. However, the indiscriminate use of antimicrobials has led to a drastic rise in antibiotic resistance, with failure of traditional eradication schemes. Bismuth was not available in this South-European country, but a single-capsule bismuth-based quadruple treatment became recently available. This study aims to determine whether this quadruple regimen is useful as a second-line or salvage therapy.
Patients and methods: This was a multicentric, retrospective study, with most patients included in a prospective database but without any direct intervention of the investigation team before or during treatment. All consecutive patients that were treated with bismuth-based quadruple therapy as second-line or salvage treatment between July-2017 and October-2018 were enrolled. Their medical records were reviewed and clinical and laboratorial parameters, as well as data on treatment efficacy and adverse events were retrieved. Patients were also contacted by telephone after treatment in order to confirm compliance (considered as adequate when at least 90% of prescribed medication was taken), adverse events and global satisfaction with this specific therapy.
Results: A total of 196 subjects were included (female – 65.8%; mean age – 55.13±13.14 years). Patients had previously completed a mean of 1.12 eradication schemes (0 to 5): triple clarithromycin-based – 33.2%; sequential – 22.4%; concomitant – 7.7%; fluoroquinolone-based – 7.1%; rifabutine-based – 1.0%. The proton pump inhibitor of choice was esomeprazole (42.9%), followed by omeprazole (24%). Compliance was achieved in 93.9% and the overall eradication rate was 90.8% (95% confidence interval: 86.7–94.4). Treatment-related adverse effects were experienced by 83 patients (42.3%), being mild in 39, moderate in 30 and severe in 15. The main drawbacks of the treatment in the patient’s perspective were its’ high price (45.9%) and the adverse effects (16.8%). Failure to eradicate H. pylori was correlated with the following: previous rifabutine-base scheme (15.4% vs. 0%) and higher number of previous treatment regimens (1.94±1.9 vs. 1.03±0.9).
Conclusion: In this South-European country a single-capsule bismuth-based quadruple therapy is an excellent alternative in patients who have failed previous eradication schemes, with acceptable compliance and side effects.
Catarina Correia, born on December 15, 1991 in Coimbra. She completed secondary education at Colegio São Martinho in Coimbra. She began her master's Degree in Medicine in September 2010 at the School of Health Sciences of the University of Beira Interior completing the same in 2016. That same year she underwent the National Examination of Seriation, obtaining a classification of 93% and position at level 101 nacionally. Her common year was at the Hospital Center and University of Coimbra. She chose the specialty of Gastroenterology in the Department of Gastroenterology of the Hospital and University Center of Coimbra and started the intership in 2018. She is currently at the beginning of her second year of residency.
E-mail: [email protected]