Impact of insufficient doses of medications on Helicobacter pylori eradication: a retrospective observational study

ABSTRACT

Background and aims

The doses of medications may influence the success of Helicobacter pylori (H. pylori) eradication. This real-world observational study aimed to explore the impact of insufficient doses of medications prescribed for the bismuth-containing quadruple therapy (BQT) regimen on successful H. pylori eradication.

Methods

We retrospectively screened the patients who were diagnosed with H. pylori infection and received BQT regimens for H. pylori eradication at our department between January 2017 and July 2020. The rate of successful H. pylori eradication was compared according to the doses of medications prescribed. Standard doses were defined according to the clinical guidelines.

Results

Overall, 1054 patients were included. The rate of successful H. pylori eradication was 78.2% (824/1054). Among them, proton pump inhibitors (PPIs) and antibiotics were prescribed at insufficient doses in 37.0% (390/1054) and 6.7% (71/1054) of patients, respectively. Furthermore, pantoprazole (98.7% [385/390]) was the most common type of PPIs prescribed at insufficient doses, and nitroimidazoles (85.9% [61/71]) were the most common type of antibiotics prescribed at insufficient doses. Among the patients receiving colloidal bismuth pectin (CBP) (200 mg tid) and standard-dose antibiotics, the rate of successful H. pylori eradication was lower in insufficient-dose PPIs group than standard-dose PPIs group (78.1% [271/347] versus 82.6% [438/530], P = 0.095). Among the patients receiving CBP (200 mg tid) and standard-dose PPIs, the rate of successful H. pylori eradication was significantly lower in insufficient-dose antibiotics group than standard-dose antibiotics group (37.8% [14/37] versus 82.6% [438/530], P < 0.0001). Among the patients receiving CBP 200 mg tid, the rate of successful H. pylori eradication was significantly lower in patients receiving both PPIs and antibiotics at insufficient doses than those at standard doses (46.4% [13/28] versus 82.6% [438/530], P < 0.0001).

Conclusion

Among the BQT regimens, PPIs and/or antibiotics, especially pantoprazole and metronidazole, are often prescribed at insufficient doses, compromising the success of H. pylori eradication.

Abbreviations

H. pylori, Helicobacter pylori; UBT, urea breath test; DPM, disintegrations per minute; BQT, bismuth-containing quadruple therapy; PPI, proton pump inhibitor; CBP, colloidal bismuth pectin; qd, once daily; bid, twice daily; tid, three times daily; qid, four times daily.

KEYWORDS:

• Helicobacter pylori
• successful eradication rate
• bismuth-containing quadruple therapy
• proton pump inhibitor
• antibiotics

Acknowledgments

The authors thank the participants of the study, including Chunmei Wang, Shaoze Ma, Guangqin Xu, Tingwei Liu, and Ying Yuan, for their help and efforts in setting up our database.

Disclosure of any financial/other conflicts of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Authors’ contributions

Conceptualization: Xingshun Qi;

Formal analysis: Xiaoye Shi, Chunmei Wang, Funjun Meng, Shaoze Ma, Guangqin Xu, Tingwei Liu, Xiaozhong Guo, Hongyu Li, and Xingshun Qi;

Data curation: Xiaoye Shi, Chunmei Wang, Shaoze Ma, Guangqin Xu, Tingwei Liu, and Xingshun Qi;

Data interpretation: Xiaoye Shi, Chunmei Wang, Funjun Meng, Shaoze Ma, Guangqin Xu, Tingwei Liu, Xiaozhong Guo, Hongyu Li, and Xingshun Qi;

Writing-original draft: Xiaoye Shi and Xingshun Qi;

Writing-review and editing: Xiaoye Shi, Chunmei Wang, Funjun Meng, Shaoze Ma, Guangqin Xu, Tingwei Liu, Xiaozhong Guo, Hongyu Li, and Xingshun Qi;

Supervision: Xingshun Qi and Hongyu Li.

All authors have made an intellectual contribution to the manuscript and approved the submission.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/00325481.2022.2105094

Additional information

Funding

There is no funding related to this work.