Eradication Rates of Empiric Helicobacter pylori Treatment Regimens by Race/Ethnicity in a Predominantly Immigrant U.S. Population

IF 4.6 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter Pub Date : 2025-12-08 DOI:10.1111/hel.70095

Min J. Kim, Isiah Gonzalez, Nia M. Choi, David Y. Graham, Hashem B. El-Serag, Mimi C. Tan

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Abstract

Background

Helicobacter pylori infections are mostly treated empirically (without antibiotic susceptibility testing). Determining eradication rates of different treatment regimens can inform antibiotic resistance. Our aim was to examine eradication rates of empiric H. pylori treatments based on treatment regimen, race/ethnicity and previous treatment status in a multiethnic U.S. population.

Materials and Methods

This was a retrospective cross-sectional study of patients with a positive H. pylori test from 7/2021 to 4/2022 at Harris Health (Houston, Texas) who had received treatment and eradication testing within 1 year. We compared eradication rates based on treatment regimen, race/ethnicity, and prior treatment and examined other possible risk factors for treatment failure using logistic regression models.

Results

Among 1106 H. pylori-infected patients, 29.2% were male, 80.6% Hispanic, 10.7% black, 2.5% white, and 83.3% were non-U.S. born with a mean age of 50.8 years (standard deviation 12.6). Most patients (57.3%) received bismuth-tetracycline-metronidazole quadruple, 21.2% clarithromycin-metronidazole-amoxicillin quadruple, 15.6% clarithromycin-amoxicillin triple, and 3.9% received clarithromycin-metronidazole triple therapies. Eradication rates were highest for bismuth-tetracycline-metronidazole quadruple (83.8%), clarithromycin-metronidazole-amoxicillin quadruple (80.3%), and clarithromycin-amoxicillin triple therapies (79.2%). In 186 (16.8%) previously treated patients, all empiric regimens achieved < 80% eradication rates. Clarithromycin-amoxicillin triple had high eradication rates (92.9%) in black patients and bismuth quadruple therapy in Asians (95.8%). Compared to bismuth quadruple therapy, clarithromycin-metronidazole triple (adjusted odds ratio [adjOR] 0.31, 95% confidence interval [CI] 0.13–0.73) and levofloxacin-amoxicillin triple (adjOR 0.20, 95% CI 0.05–0.89) regimens were associated with treatment failure, whereas clarithromycin-amoxicillin quadruple and triple therapies were not.

Conclusions

Empiric bismuth quadruple therapy had the highest eradication rate while metronidazole and levofloxacin triple therapies had the lowest. Eradication rates may thus serve as a surrogate clinical endpoint when choosing empiric therapies.

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在以移民为主的美国人群中，不同种族/民族幽门螺杆菌治疗方案的根除率

背景：幽门螺杆菌感染大多是经验性治疗（没有抗生素药敏试验）。确定不同治疗方案的根除率可以为抗生素耐药性提供信息。我们的目的是根据治疗方案、种族/民族和美国多种族人群以前的治疗状况，检查幽门螺杆菌治疗的根除率。材料和方法：这是一项回顾性横断面研究，研究对象是Harris Health （Houston, Texas）在2021年7月至2022年4月期间幽门螺杆菌检测呈阳性的患者，这些患者在一年内接受了治疗和根除检测。我们比较了基于治疗方案、种族/民族和既往治疗的根除率，并使用逻辑回归模型检查了治疗失败的其他可能危险因素。结果：1106例幽门螺杆菌感染患者中，男性占29.2%，西班牙裔占80.6%，黑人占10.7%，白人占2.5%，非美国人占83.3%。平均出生年龄50.8岁（标准差12.6）。接受铋-四环素-甲硝唑四联治疗的患者占57.3%，接受克拉霉素-甲硝唑-阿莫西林四联治疗的患者占21.2%，接受克拉霉素-阿莫西林三联治疗的患者占15.6%，接受克拉霉素-甲硝唑三联治疗的患者占3.9%。铋-四环素-甲硝唑四联疗法根除率最高（83.8%），克拉霉素-甲硝唑-阿莫西林四联疗法根除率最高（80.3%），克拉霉素-阿莫西林三联疗法根除率最高（79.2%）。结论：经验铋四联疗法根除率最高，甲硝唑和左氧氟沙星三联疗法根除率最低。因此，在选择经验性疗法时，根除率可以作为替代临床终点。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Helicobacter 医学-微生物学

CiteScore

8.40

自引率

9.10%

发文量

审稿时长

2 months

期刊介绍： Helicobacter is edited by Professor David Y Graham. The editorial and peer review process is an independent process. Whenever there is a conflict of interest, the editor and editorial board will declare their interests and affiliations. Helicobacter recognises the critical role that has been established for Helicobacter pylori in peptic ulcer, gastric adenocarcinoma, and primary gastric lymphoma. As new helicobacter species are now regularly being discovered, Helicobacter covers the entire range of helicobacter research, increasing communication among the fields of gastroenterology; microbiology; vaccine development; laboratory animal science.