Clinical audit of current Helicobacter pylori treatment outcomes in Singapore
Introduction: H. pylori eradication reduces the risk of gastric malignancies and peptic ulcer disease. First-line therapies include 14-day PAC (proton pump inhibitor [PPI], amoxicillin, clarithromycin) and PBMT (PPI, bismuth, metronidazole, tetracycline). Second-line therapies include 14-day PBMT an...
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| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer – Medknow Publications
2022-09-01
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| Series: | Singapore Medical Journal |
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| Online Access: | https://journals.lww.com/10.11622/smedj.2021105 |
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| _version_ | 1823861029312921600 |
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| author | Tiing Leong Ang Kim Wei Lim Daphne Ang Yu Jun Wong Malcolm Tan Andrew Siang Yih Wong |
| author_facet | Tiing Leong Ang Kim Wei Lim Daphne Ang Yu Jun Wong Malcolm Tan Andrew Siang Yih Wong |
| author_sort | Tiing Leong Ang |
| collection | DOAJ |
| description | Introduction:
H. pylori eradication reduces the risk of gastric malignancies and peptic ulcer disease. First-line therapies include 14-day PAC (proton pump inhibitor [PPI], amoxicillin, clarithromycin) and PBMT (PPI, bismuth, metronidazole, tetracycline). Second-line therapies include 14-day PBMT and PAL (PPI, amoxicillin, levofloxacin). This clinical audit examined current treatment outcomes in Singapore.
Methods:
Clinical data of H. pylori-positive patientswho underwent empirical first- and second-line eradication therapies from 1 January 2017 to 31 December 2018 were reviewed. Treatment success was determined by 13C urea breath test performed at least 4 weeks after treatment and 2 weeks off PPI.
Results:
A total of 963 patients (862 PAC, 36 PMC [PPI, metronidazole, clarithromycin], 18 PBMT, 13 PBAC [PAC with bismuth], 34 others) and 98 patients (62 PMBT, 15 PAL, 21 others) received first-and second-line therapies respectively. A 14-day treatment duration was appropriately prescribed for first- and second-line therapies in 65.2% and 82.7% of patients, respectively. First-line treatment success rates were noted for PAC (seven-day: 76.9%, ten-day: 88.3%, 14-day: 92.0%), PMC (seven-day: 0, ten-day: 75.0%, 14-day: 69.8%), PBMT (ten-day: 100%, 14-day: 87.5%) and PBAC (14-day: 100%). 14-day treatment was superior to seven-day treatment (90.8% vs. 71.4%; P = 0.028). PAC was superior to PMC (P < 0.001) but similar to PBMT (P = 0.518) and PBAC (P = 0.288) in 14-day therapies. 14-day second-line PAL and PBMT had similar efficacy (90.9% vs. 82.4%; P = 0.674).
Conclusion:
First-line empirical treatment using PAC, PBMT and PBAC for 14 days had similar efficacy. Success rates for second-line PBMT and PAL were similar. |
| format | Article |
| id | doaj-art-66713236bec248c2a8f46ce7e59bb183 |
| institution | Kabale University |
| issn | 0037-5675 2737-5935 |
| language | English |
| publishDate | 2022-09-01 |
| publisher | Wolters Kluwer – Medknow Publications |
| record_format | Article |
| series | Singapore Medical Journal |
| spelling | doaj-art-66713236bec248c2a8f46ce7e59bb1832025-02-10T05:29:08ZengWolters Kluwer – Medknow PublicationsSingapore Medical Journal0037-56752737-59352022-09-0163950350810.11622/smedj.2021105Clinical audit of current Helicobacter pylori treatment outcomes in SingaporeTiing Leong AngKim Wei LimDaphne AngYu Jun WongMalcolm TanAndrew Siang Yih WongIntroduction: H. pylori eradication reduces the risk of gastric malignancies and peptic ulcer disease. First-line therapies include 14-day PAC (proton pump inhibitor [PPI], amoxicillin, clarithromycin) and PBMT (PPI, bismuth, metronidazole, tetracycline). Second-line therapies include 14-day PBMT and PAL (PPI, amoxicillin, levofloxacin). This clinical audit examined current treatment outcomes in Singapore. Methods: Clinical data of H. pylori-positive patientswho underwent empirical first- and second-line eradication therapies from 1 January 2017 to 31 December 2018 were reviewed. Treatment success was determined by 13C urea breath test performed at least 4 weeks after treatment and 2 weeks off PPI. Results: A total of 963 patients (862 PAC, 36 PMC [PPI, metronidazole, clarithromycin], 18 PBMT, 13 PBAC [PAC with bismuth], 34 others) and 98 patients (62 PMBT, 15 PAL, 21 others) received first-and second-line therapies respectively. A 14-day treatment duration was appropriately prescribed for first- and second-line therapies in 65.2% and 82.7% of patients, respectively. First-line treatment success rates were noted for PAC (seven-day: 76.9%, ten-day: 88.3%, 14-day: 92.0%), PMC (seven-day: 0, ten-day: 75.0%, 14-day: 69.8%), PBMT (ten-day: 100%, 14-day: 87.5%) and PBAC (14-day: 100%). 14-day treatment was superior to seven-day treatment (90.8% vs. 71.4%; P = 0.028). PAC was superior to PMC (P < 0.001) but similar to PBMT (P = 0.518) and PBAC (P = 0.288) in 14-day therapies. 14-day second-line PAL and PBMT had similar efficacy (90.9% vs. 82.4%; P = 0.674). Conclusion: First-line empirical treatment using PAC, PBMT and PBAC for 14 days had similar efficacy. Success rates for second-line PBMT and PAL were similar.https://journals.lww.com/10.11622/smedj.2021105first line treatmenthelicobacter pylorisecond line treatment |
| spellingShingle | Tiing Leong Ang Kim Wei Lim Daphne Ang Yu Jun Wong Malcolm Tan Andrew Siang Yih Wong Clinical audit of current Helicobacter pylori treatment outcomes in Singapore Singapore Medical Journal first line treatment helicobacter pylori second line treatment |
| title | Clinical audit of current Helicobacter pylori treatment outcomes in Singapore |
| title_full | Clinical audit of current Helicobacter pylori treatment outcomes in Singapore |
| title_fullStr | Clinical audit of current Helicobacter pylori treatment outcomes in Singapore |
| title_full_unstemmed | Clinical audit of current Helicobacter pylori treatment outcomes in Singapore |
| title_short | Clinical audit of current Helicobacter pylori treatment outcomes in Singapore |
| title_sort | clinical audit of current helicobacter pylori treatment outcomes in singapore |
| topic | first line treatment helicobacter pylori second line treatment |
| url | https://journals.lww.com/10.11622/smedj.2021105 |
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