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EFFECTIVENESS OF REPEATED USE OF AMOXICILLIN–CLARITHROMYCIN TRIPLE THERAPY AND BISMUTH QUADRUPLE THERAPY AFTER PRIOR FAILURE: PRELIMINARY RESULTS FROM THE EUROPEAN REGISTRY ON HELICOBACTER PYLORI MANAGEMENT (HP-EUREG)

Elisa Cantú-Germano 1, Leticia Moreira Ruiz 1, Laimas Virginijus Jonaitis* 2, Ángeles Pérez-Aísa 3, Bojan Tepes 4, Umud Mahmudov 5, Samuel Jesús Martínez-Domínguez 6, Gülüstan Babayeva 7, Javier Tejedor-Tejada 8, Alfredo J. Lucendo 9, Sayar Abdulkhakov 10, Liudmila Vologzhanina 11, Pavel Bogomolov 12, Emin Mammadov 7, Blas José Gómez-Rodríguez 13, Monica Perona 14, Maja Denkovski 15, Antonio Moreno 16, Irina Voynovan 17, Manuel Pabon-Carrasco 18, Thomas Butler 19, Rashad Hasanov 20, Oscar Núñez Martínez 21, Tatiana Ilchishina 22, Farid Guliyev 23, Antonio Gasbarrini 24, Jose Maria Huguet 25, Miguel Areia 26, Antonietta Gerarda Gravina 27, Sergei Alekseenko 28, M. Soledad Marcos 29, Jesús Barrio 30, Fernando Bermejo 31, Dmitrii Andreev 32, Luis Bujanda 33, Juozas Kupcinskas 2, Marcis Leja 34, Dmitry S. Bordin 35, Sinead Smith 36, Ricardo Pinto 37, Mónica Sánchez Alonso 38, Ramón Pajares Villarroya 39, Manuel Jiménez-Moreno 40, Irene Arteagoitia 41, Anna Cano-Catala 42, Pablo Parra 43, Olga P. Nyssen 43, Francis Mégraud 44, Colm O'Morain 36, Javier P. Gisbert 43

Affiliations

1 Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain

2 Lithuanian University of Health Sciences, Kaunas, Lithuania

3 Hospital Universitario Costa del Sol, Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Marbella, Spain

4 DC Rogaska, Rogaska Slatina, Slovenia

5 Modern Hospital, Baku, Azerbaijan

6 Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Zaragoza, Spain

7 Azerbaijan State Advanced Training Institute for Doctors named by A. Aliyev, Baku, Azerbaijan

8 Hospital Universitario de Cabueñes, Gijón, Asturias, Spain

9 Hospital General de Tomelloso, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM),

10 Kazan (Volga region) Federal University, Kazan State Medical University, Kazan, Russian Federation

11 Gastrocentr, Perm, Russian Federation

12 Universal Clinic Private Medical Center, Moscow, Russian Federation

13 Hospital Universitario Virgen Macarena, Sevilla, Spain

14 Hospital Quirón Marbella, Marbella, Spain

15 Interni Oddelek, Diagnostic Centre, Bled, Slovenia

16 Hospital Universitario Virgen del Rocío, Sevilla, Spain

17 A.S. Loginov Moscow Clinical Scientific Center, Moscow, Russian Federation

18 Hospital Universitario Virgen de Valme, Sevilla, Spain

19 Clinical Medicine, Trinity College Dublin, Tallaght University Hospital, Dublin, Ireland

20 German Hospital, Baku, Azerbaijan

21 Hospital Universitario La Moraleja, Faculty of Medicine, Universidad Francisco de Vitoria, Faculty of Medicine, Universidad CEU San Pablo, Madrid, Spain

22 SM-clinic, Saint-Petersburg, Russian Federation

23 National Oncology Centre, Baku, Azerbaijan

24 Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy

25 Hospital General Universitario de Valencia, Valencia, Spain

26 Portuguese Oncology Institute of Coimbra, Faculty of Medicine of the University of Porto (FMUP), RISE@CI-IPO (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto), Coimbra, Portugal

27 University of study of Campania "L. Vanvitelli", Naples, Italy

28 Far Estern State Medical University, Khabarovsk, Russian Federation

29 Hospital 12 de Octubre, Madrid, Spain

30 Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain

31 Hospital Universitario de Fuenlabrada, Madrid, Spain

32 Russian University of Medicine, Moscow, Russian Federation

33 Biodonostia Health Research Institute, Department of Medicine, Universidad del País Vasco (UPV/EHU), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), San Sebastián, Spain

34 Digestive Diseases Centre, Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia

35 A. S. Loginov Moscow clinical scientific center, Department of outpatient therapy and family medicine, Tver State Medical University, Department of propaedeutic of internal diseases and gastroenterology, Moscow, Russian Federation

36 Trinity College Dublin, Dublin, Ireland

37 Centro Hospitalar do Porto, Instituto De Ciências Biomédicas de Abel Salazar, Universidade do Porto, Center for Research in Health Technologies and Information Systems (CINTESIS), Porto, Portugal

38 Hospital Universitario Santa Bárbara, Ciudad Real, Spain

39 Hospital Universitario Infanta Sofía, Faculty of Medicine, Universidad Europea de Madrid, Madrid, Spain

40 Hospital Universitario de Burgos, Burgos, Spain

41 Hospital Universitario de Cruces, Vizcaya, Spain

42 Gastrointestinal Oncology, Endoscopy and Surgery (GOES) research group, Althaia Xarxa Assistencial Universitària de Manresa, Institut de Recerca i Innovació en Ciències de la Vida i de la Salut de la Catalunya Central (IRIS-CC), Manresa, Spain

43 Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain

44 INSERM U1312, Université de Bordeaux, Bordeaux, France

Summary

AI Generated

Registry data from 2013-2024 show that repeating the same Helicobacter pylori eradication regimen after initial failure can achieve substantial effectiveness, particularly with 14-day triple therapy or single-capsule bismuth quadruple therapy in second-line treatment.

Triple therapy with amoxicillin-clarithromycin repeated in second line after first-line failure achieved 74% overall effectiveness, with efficacy increasing by treatment duration: 50% at 7 days, 72% at 10 days, and 82% at 14 days.
Bismuth quadruple therapy as single-capsule repeated in second line after failure with the same regimen achieved over 90% effectiveness and almost 80% effectiveness when repeated in third line.
Classical bismuth quadruple therapy repeated in second line showed 69% effectiveness, though patient numbers were limited (n=6).
The analysis included 230 patients who received repeated triple therapy, 101 who received repeated single-capsule bismuth therapy, and 13 who received repeated classical bismuth therapy across multiple treatment lines from the European Registry on Hp management.
Findings contrast with current guideline recommendations that discourage repeated use of the same regimen after eradication failure.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

After an initial attempt to eradicate Helicobacter pylori (Hp), around 20% of patients remain infected. As treatment failures accumulate, the effectiveness of subsequent Hp therapies tends to decrease. Therefore, current clinical guidelines discourage repeated use of the same treatment regimen following an initial failure.

Aims & Methods

To evaluate the use and effectiveness of the triple therapy with amoxicillin-clarithromycin and of the bismuth quadruple therapy (either classical and as single-capsule format) when empirically prescribed as retreatment, despite previous eradication failure with the same regimen.
All patients registered at e-CRF AEG-REDCap as part of the European Registry on Hp management (Hp-EuReg) from 2013-2024, who had received triple therapy with amoxicillin-clarithromycin or bismuth quadruple therapy (either classical or as single-capsule) in at least 2 different treatment lines (not necessarily consecutive), were analysed separately.

Results

Triple therapy with amoxicillin-clarithromycin: Out of 518 patients treated with triple therapy from 2^nd to 6^th rescue treatment line, 230 cases received the same therapy at least in 2 different treatment lines: 199 re-treatments in 2^nd line having previously failed in 1^st line with this therapy; 19 re-treatments in 3^rd line (of which 9 had previously received the same therapy only in the 1^st line and 10 had received the same therapy in both 1^st and 2^nd line); 4 in 4^th line; 5 in 5^th line; and further 3 in 6^th line. The overall effectiveness of triple therapy with amoxicillin-clarithromycin when empirically prescribed repeatedly in 2^nd line was 74%. When the effectiveness was subanalysed by treatment length, there were increasing efficacy rates according to it: 50% with 7 days, 72% with 10 days, and 82% with 14 days. The cases retreated in 3^rd line had an overall effectiveness of 56%.
Bismuth quadruple classical therapy: Out of 672 patients treated with bismuth quadruple classical therapy from 2^nd to 6^th rescue treatment line, 13 cases received the same therapy at least in 2 different treatment lines: 6 re-treatments in 2^nd line, having previously failed in 1^st line; 2 re-treatments in 3^rd line, both had previously received the same therapy in 2^nd line; 2 in 4^th line; 1 in 5^th line; and further 2 in 6^th line. The effectiveness of bismuth quadruple classical therapy when empirically prescribed repeatedly in the 2^nd line was 69%, although the number of patients in this cohort was limited.
Bismuth quadruple therapy as single-capsule: Out of 2,579 patients treated with the single-capsule from 2^nd to 6^th rescue treatment line, 101 cases received the same therapy at least in 2 different treatment lines: 67 re-treatments in 2^nd line having previously failed in 1^st line with the single-capsule; 16 re-treatments in 3^rd line, of which 12 had previously received this same therapy in 2^nd line; 11 in 4^th line; 4 in 5^th line; and further 3 in 6^th line. The effectiveness of bismuth quadruple therapy as single-capsule when empirically prescribed repeatedly in 2^nd line was over 90%, and achieved almost 80% in all cases retreated in the 3^rd line.

Conclusion

Repeated use of triple therapy with amoxicillin-clarithromycin in patients with prior eradication failures with the same regimen demonstrated notable success rates, particularly in 2^nd line re-treatments lasting 14 days (>80%). On the other hand, bismuth quadruple therapy as single-capsule, when prescribed as re-treatment in 2^nd line after previous failure with the same therapy, achieved optimal effectiveness (>90%).

References

1. Malfertheiner P, Megraud F, Rokkas T, Gisbert JP, Liou JM, Schulz C, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022;71(9):1724–62.
2. Nyssen OP, Vaira D, Pérez Aísa Á, Rodrigo L, Castro-Fernandez M, Jonaitis L, et al. Empirical Second-Line Therapy in 5000 Patients of the European Registry on Helicobacter pylori Management (Hp-EuReg). Clin Gastroenterol Hepatol. 2022;20(10):2243–57.

Disclosure

Olga P. Nyssen has served as a speaker or has received research funding from Allergan, Mayoly Spindler, Richen, Biocodex and Juvisé.
Javier P. Gisbert has served as speaker, consultant, and advisory member for or has received research funding from Mayoly, Allergan/Abbvie, Diasorin, Richen, Juvisé, Biocodex.
The remaining authors declare no conflicts of interest.

Conference

UEG Week Berlin 2025

Topics

Stomach & H. Pylori

Submission format

Abstract

Session

H. pylori: Real world data (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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