Helicobacter Pylori First-Line and Rescue Treatments in the Presence of Penicillin Allergy

Background Helicobacter pylori eradication is a challenge in penicillin allergy. Aim To assess the efficacy and safety of first-line and rescue treatments in patients allergic to penicillin. Methods Prospective multicenter study. Patients allergic to penicillin were given a first-line treatment comprising (a) 7-day omeprazole‐clarithromycin‐metronidazole and (b) 10-day omeprazole‐bismuth‐tetracycline‐metronidazole. Rescue treatments were as follows: (a) bismuth quadruple therapy; (b) 10-day PPI‐clarithromycin‐levofloxacin; and (c) 10-day PPI‐clarithromycin‐rifabutin. Eradication was confirmed by 13 C-urea breath test. Compliance was determined through questioning and recovery of empty medication envelopes. Adverse effects were evaluated by questionnaires. Results In total, 267 consecutive treatments were included. (1) First-line treatment: Per-protocol and intention-totreat eradication rates with omeprazole‐clarithromycin‐ metronidazole were 59 % (62/105; 95 % CI 49‐62 %) and 57 % (64/112; 95 % CI 47‐67 %). Respective figures for PPI‐bismuth‐tetracycline‐metronidazole were 75 % (37/ 49; 95 % CI 62‐89 %) and 74 % (37/50; 95 % CI (61‐87 %) (p \ 0.05). Compliance with treatment was 94 and 98 %, respectively. Adverse events were reported in 14 % with both regimens (all mild). (2) Second-line treatment: Intention-to-treat eradication rate with omeprazole‐clarithromycin‐levofloxacin was 64 % both after triple and quadruple failure; compliance was 88‐100 %, with 23‐29 % adverse effects (all mild). (3) Third-/fourth-line treatment: Intention-to-treat eradication rate with PPI‐ clarithromycin‐rifabutin was 22 %.