ArticleBMC infectious diseases2025
Helicobacter pylori eradication rate following first line non-bismuth quadruple therapy regimen in Tunisian patients: the HPERAD study.
Article in BMC infectious diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionHelicobacter pylori (H. pylori) eradication is a continuously challenging issue as antibiotic resistance is evolving and adversely affecting outcomes of previously effective treatments. Continual assessment and modification of therapeutic approaches is necessary.
aimThe aim of our study was to evaluate H. pylori eradication rate in Tunisian patients treated by non-bismuth quadruple therapy and to investigate treatment failure factors.
methodsWe conducted a prospective multicentric study including patients with H. pylori infection. For all patients, concomitant therapy (amoxicillin 1 g, clarithromycin 500 mg and metronidazole 500 mg plus esomeprazole 40 mg) twice daily for 14 days was prescribed. Mutations conferring resistance of H. pylori to clarithromycin were detected using polymerase chain reaction on gastric biopsies. Eradication was assessed using the urea breath test.
results414 patients were included. The mean age was 44.7 ± 14.3 with a sex ratio of M/F = 0.53. Mutations conferring resistance of H. pylori to clarithromycin were observed in 76 patients (18.35%). During follow-up, adverse effects to treatment occurred in 34.5% of patients. Eradication rate was 88.2% (95% CI: [85.1–91.3]) in per protocol analysis. In multivariate analysis, female gender (OR:2.924, 95% CI (1.340–6.380), p = 0.009) and the presence of clarithromycin resistance gene (OR:4.671, 95% CI (2.444–8.925), p < 0.001) were predictors of treatment failure.
conclusionConcomitant therapy showed an eradication rate below 90% in Tunisian patients, mainly due to clarithromycin resistance and female gender. However, non-bismuth quadruple therapy remains a viable alternative option, achieving eradication in more than 8 out of 10 patients. CLINICAL TRIAL: Not applicable
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