Patterns of quadruple therapy use including bismuth for Helicobacter pylori eradication: a cohort study in the French national claims database

Summary Background.- Quadruple therapy using a single capsule formulation of bismuth, metronidazole, and tetracycline (BMT; Pylera®), associated with omeprazole for the eradication of Helicobacter pylori, represents the reintroduction of bismuth in France after 40 years. Objective.- To describe the real-life patterns of use of BMT following a request from the French health authorities. Methods.- Patients with a first BMT dispensing (index date, ID), with one year of data before and after ID, were identified in the French nationwide claims database 1/97 sample. Misuse of BMT was defined as dispensing >1 pack of BMT at ID or absence of a diagnostic test in the preceding year. Results.- 540 patients were included. Prescribers were gastroenterologists (N = 243; 45%) and general practitioners (N = 160; 30%). A proton pump inhibitor was co-dispensed to 504 patients (96%). Ten patients (2%) had contraindications to BMT. Fifty-nine patients (11%) met the misuse criteria: ten (2%) were dispensed >1 pack of BMT and 49 (9%) had not had a diagnostic test for H. pylori in the previous year. During follow-up, 27 patients (5%) required retreatment (treatment failure). Conclusion.- In this real-life study, most patients were dispensed only one pack of BMT, consistent with recommendations. Misuse related principally to the absence of prior diagnostic test for H. pylori.