TBA (24W129)

Bismuth Quadruple Therapy with Doxycycline is an effective first line therapy in an Irish Cohort for Helicobacter pylori.

Author(s)

Conor Costigan1,2, Mark Comerford2, Ronan Whitmarsh3, Kevin Van Der Merwe4, Gillian Madders2, Jim O’Connell2, Thomas Butler1, Stephen Molloy1, Fintan O’Hara1,2, Barbara Ryan2, Niall Breslin2, Sarah O’Donnell2, Anthony O’Connor2, Sinead Smith,2 Syafiq Ismail3, Vikrant Parihar4, Deirdre McNamara1,2.

Department(s)/Institutions

1. Trinity Academic Gastroenterology Group, Trinity College Dublin, Ireland 2. Dept. of Gastroenterology, Tallaght University Hospital, Dublin, Ireland 3. Dept. of Gastroenterology, Cavan Monaghan Hospital, Cavan/Monaghan, Ireland 4. Dept. of Gastroenterology, Letterkenny University Hospital, Donegal, Ireland

Introduction

There has been a reduction in successful eradication rates for H. pylori recently, attributed to increasing antibiotic resistance. In areas of high clarithromycin & metronidazole resistance, Maastricht VI guidelines recommend Bismuth Quadruple Therapy(BQT) as first-line therapy, however availability was poor in Ireland until recently. Similarly Tetracycline use, a component of BQT, is restricted locally with Doxycycline reimbursed for most indications. Reduced BQT efficacy containing Doxycycline(BQT-D) rather than Tetracycline(BQT-T) has been reported.

Aims/Background

To assess the efficacy of BQT-D therapy for H. pylori eradication in an Irish cohort.

Method

All patients testing positive for H. pylori in 3 Irish referral centres were treated with BQT-D (Bismuth subcitrate 120mg QDS, Metronidazole 400mg TDS, Doxycycline 100mg BD & Esomeprazole 40mg BD x14 days) over 8 months. Eradication was confirmed with UBT or stool antigen >4weeks after cessation of therapy. Demographics, prior treatments & outcomes were recorded and analysed.

Results

217 patients completed post-eradication testing. 124(57%) were female, mean age 52. 180 patients(82.5%) were treatment-naive. 163(91%) of these had successful eradication. Gender and age had no effect on eradication(p=0.3091, p=0.962 AUC=0.5036 respectively). No serious AEs were reported. 11 individuals(7%) commented on the complicated nature of the regimen, with 11 tablets being taken at 5 different times daily.

Conclusions

BQT as first line therapy for H. pylori infection is highly effective in a high dual resistance population. Doxycycline substitution for tetracycline still achieved > 90% eradication. BQT as second line treatment as expected performed less well. Our data supports BQT despite the complicated regime as a first line treatment.