Helicobacter pylori eradication treatment dispensing in the Irish General Medical Services population from 2012 to 2022: a repeated cross-sectional analysis.

Abstract

Background: Helicobacter pylori (H. pylori) infection contributes substantially to peptic ulcer disease and gastric cancer. Increasing clarithromycin resistance has shifted guidelines towards 14-day treatment, bismuth quadruple therapy, and second-generation proton pump inhibitors (PPIs). Most studies evaluating H. pylori treatment trends reflect gastroenterologist prescribing rather than primary care.

Aim: This study aimed to examine demographic differences in H. pylori eradication treatment dispensing according to sex and age group, and describe trends in eradication regimens, PPI selection, and treatment duration from 2012 to 2022 in relation to clinical guidelines. A secondary aim was to explore concomitant dispensing of multiple PPIs.

Method: Our repeated cross-sectional study used a pharmacy claims database including General Medical Services (GMS) patients (~ 30% of the Irish population) from 2012 to 2022. Demographic differences (male/female; aged <45/≥45 years) in treatment dispensing were assessed using annual GMS population proportions. Annual dispensing rates were calculated for eradication regimens and PPIs. Temporal trends in PPI use and treatment duration (7 vs. 14 days) were analysed using negative binomial regression.

Results: In total, 112,816 eradication treatments were dispensed. Annually, a higher proportion of women than men (0.46-0.65% vs. 0.40-0.60%) and individuals aged ≥ 45 than <45 years (0.64-0.81% vs. 0.26-0.46%) received treatment. Clarithromycin-amoxicillin triple therapy accounted for 72.4% of treatments, and bismuth quadruple therapy 0.1%. Esomeprazole was the most dispensed PPI (47.5%). Same-day multiple-PPI dispensing occurred on 2.7% of treatment-dispensing dates. First-generation PPI dispensing decreased 5.3% annually (incidence rate ratio [IRR] 0.95, 95% confidence interval [CI] 0.93-0.97); the second-generation annual rate change was 7.6% higher (interaction IRR 1.08, 95% CI 1.05-1.11), corresponding to a 1.9% annual increase (IRR 1.02, 95% CI 1.00-1.04). Seven-day dispensing decreased 16.2% annually (IRR 0.84, 95% CI 0.81-0.87); the annual rate change for 14-day regimens was 53.3% higher (interaction IRR 1.53, 95% CI 1.46-1.62), corresponding to a 28.5% annual increase (IRR 1.28, 95% CI 1.24-1.33).

Conclusion: Increasing use of 14-day eradication treatments and esomeprazole suggests improving alignment with clinical guidelines. Continued reliance on clarithromycin-based triple therapy, minimal bismuth quadruple therapy use, and potential PPI duplication highlight opportunities for medicines optimisation.