Introduction: Helicobacter pylori(H. pylori) is the most common chronic bacterial infection and resistance pattern is thought to be increasing. The aim of our study was to determine in adult patients at a safety-net hospital with confirmed H. pylori infection the overall failure rate, prescribing patterns, and the failure rate of quadruple therapy compared to triple therapy.
Methods: We conducted a retrospective cohort study at a safety-net hospital from 2020-2021. Linked data sources were extracted, including pathology results from endoscopy, H. pylori stool antigen, and H. pylori serology tests. We included consecutive adult patients with a diagnosis of H. pylori infection by serology, stool, or histology, who were prescribed antibiotic therapy, and who had confirmed eradication testing by either stool antigen or histology. Patients who were diagnosed with H. pylori but did not receive treatment, or those who received treatment but did not have confirmation testing were excluded. Descriptive statistics and chi-square tests were performed.
Results: 100 patients were included in the analysis to date. Characteristics of patients with confirmed H. pylori infection included a median age of 47 (range 18-74), 61% female, and 54% Hispanic ethnicity followed by 21% Asian. 86% of patients received triple therapy compared to 14% who received quadruple therapy. 90% received a 14-day antibiotic regimen compared to 10% who received a 10-day regimen. The overall H. pylori treatment failure rate was 16%. The failure rate of quadruple therapy was 28.6% compared to 14% for triple therapy (p=0.16). Women were somewhat more likely to experience treatment failure (21.3% vs. 7.7%, p=0.07) while Asians had the lowest overall failure rate of 4.8% (p=0.10).
Discussion: In this retrospective cohort study of adult patients at a safety net hospital with confirmed H. pylori infection, the overall failure rate was modestly lower than the published literature. Moreover, triple therapy tended to be more effective than quadruple therapy. Increased power and multivariable analysis are needed to account for confounding in triple therapy compared to quadruple therapy by gender and race/ethnicity.
