Effectiveness of different treatment regimens in H. pylori eradication – local clinical experience

Abstract

Background. The eradication of H. pylori infection remains a challenge in medical practice, especially in the context of increasing antimicrobial resistance. It is assumed that in the Republic of Moldova, the infection prevalence exceeds 60%; therefore, optimizing eradication strategies has become a long-term priority. Objective(s). Assessment of the most effective treatment regimens for H. pylori eradication by directly comparing the success rates of different protocols applied in local clinical practice. Materials and methods. Data on the efficacy of H. pylori eradication were compared in a cohort of 68 patients treated with 7 distinct regimens, including bismuth- or levofloxacinbased quadruple therapy, non-bismuth hybrid therapy and classic or metronidazole-based triple therapy. Eradication success was evaluated by fecal antigen testing at the end of treatment. Results. The results showed an overall eradication rate of 77.9% (n=53). Hybrid therapy with levofloxacin, administered to 17 patients, achieved a 100% success rate, with similar efficacy reported for classic bismuth quadruple therapy (n=2) and levofloxacin-based quadruple therapy (n=3). Non-bismuth hybrid therapy (n=17) recorded a success rate of 82.35%. The results were considerably lower for the following therapies: bismuth quadruple therapy with amoxicillin (n=15), classic triple therapy (n=9), and triple therapy with metronidazole and clarithromycin (n=5), which showed success rates of only 66.7%, 44.4%, and 60%, respectively. Conclusion(s). The data support the preferential use of quadruple and hybrid regimens including levofloxacin or bismuth and reconfirm the increasing inefficacy of standard triple therapies. Reevaluation of therapeutic algorithm and prioritization of regimens adapted to the local resistance profile are necessary.