Clinical audit of current <i>Helicobacter pylori</i> treatment outcomes in Singapore.

Tiing Leong Ang; Kim Wei Lim; Daphne Ang; Yu Jun Wong; Malcolm Tan; Andrew Siang Yih Wong

Return

Clinical audit of current Helicobacter pylori treatment outcomes in Singapore.

Author: Tiing Leong ANG ^{1
,

2} ; Kim Wei LIM ³ ; Daphne ANG ^{1
,

2} ; Yu Jun WONG ^{1
,

2} ; Malcolm TAN ^{1
,

2} ; Andrew Siang YIH WONG ^{4
,

5}
Author Information

1. Department of Gastroenterology and Hepatology
2. Digestive Disease Centre, Changi General Hospital, Singapore.
3. Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
4. Digestive Disease Centre
5. Department of Surgery, Changi General Hospital, Singapore.
Publication Type:Journal Article
Keywords: First line treatment; Helicobacter pylorix; second line treatment
MeSH: Humans; Helicobacter pylori; Clarithromycin/therapeutic use*; Helicobacter Infections/drug therapy*; Metronidazole/therapeutic use*; Bismuth/therapeutic use*; Singapore; Drug Therapy, Combination; Amoxicillin/therapeutic use*; Proton Pump Inhibitors/therapeutic use*; Anti-Bacterial Agents/therapeutic use*; Treatment Outcome; Clinical Audit
From:Singapore medical journal 2022;63(9):503-508
CountrySingapore
Language:English
Abstract: INTRODUCTION:H. pylori eradication reduces the risk of gastric malignancies and peptic ulcer disease. First-line therapies include 14-day PAC (proton pump inhibitor [PPI], amoxicillin, clarithromycin) and PBMT (PPI, bismuth, metronidazole, tetracycline). Second-line therapies include 14-day PBMT and PAL (PPI, amoxicillin, levofloxacin). This clinical audit examined current treatment outcomes in Singapore.
METHODS:Clinical data of H. pylori-positive patientswho underwent empirical first- and second-line eradication therapies from 1 January 2017 to 31 December 2018 were reviewed. Treatment success was determined by ¹³C urea breath test performed at least 4 weeks after treatment and 2 weeks off PPI.
RESULTS:A total of 963 patients (862 PAC, 36 PMC [PPI, metronidazole, clarithromycin], 18 PBMT, 13 PBAC [PAC with bismuth], 34 others) and 98 patients (62 PMBT, 15 PAL, 21 others) received first-and second-line therapies respectively. A 14-day treatment duration was appropriately prescribed for first- and second-line therapies in 65.2% and 82.7% of patients, respectively. First-line treatment success rates were noted for PAC (seven-day: 76.9%, ten-day: 88.3%, 14-day: 92.0%), PMC (seven-day: 0, ten-day: 75.0%, 14-day: 69.8%), PBMT (ten-day: 100%, 14-day: 87.5%) and PBAC (14-day: 100%). 14-day treatment was superior to seven-day treatment (90.8% vs. 71.4%; P = 0.028). PAC was superior to PMC (P < 0.001) but similar to PBMT (P = 0.518) and PBAC (P = 0.288) in 14-day therapies. 14-day second-line PAL and PBMT had similar efficacy (90.9% vs. 82.4%; P = 0.674).
CONCLUSION:First-line empirical treatment using PAC, PBMT and PBAC for 14 days had similar efficacy. Success rates for second-line PBMT and PAL were similar.