Online registry for nationwide database of Helicobacter pylori eradication in Korea: Correlation of antibiotic use density with eradication success

Abstract

Background The Helicobacter pylori eradication rate has decreased with increasing antibiotic resistance. We conducted a prospective, nationwide, multicenter registry study to monitor the real status of H. pylori eradication therapy and to investigate the association between eradication success and antibiotic use density in Korea. Materials and Methods We enrolled 9318 patients undergoing H. pylori eradication therapy from 37 hospitals through “on‐line database registry” from October 2010 to July 2015. Demographic data, detection methods, treatment indications, regimens, durations, compliance, adverse events, and eradication results were collected. The use of all commercially available eradication antibiotics was analyzed through the Korean National Health Insurance data of the Health Insurance Review and Assessment Service. The defined daily dose of antibiotics was used to standardize drug use comparisons. Results Finally, 6738 patients were analyzed. The overall eradication rate of first‐line therapy was 71.8%. The eradication success rates were 71.7%, 86.9%, and 74.0% for standard triple therapy for 7 days, quadruple therapy, and concomitant therapy, respectively. The eradication success rate in naive patients was higher than that in those who previously underwent H. pylori eradication. Eradication success was significantly associated with younger age, female sex, and high compliance. Regional differences in eradication rates were observed. The yearly use density of clarithromycin increased statistically in seven regions across the country from 2010 to 2015. The yearly use density of amoxicillin in the Gyeongsang and Chungcheong areas was significantly increased (P < .01), whereas that of other macrolides was significantly lower in the Gyeonggi area than in other areas (P = .01). The overall use of eradication antibiotics has increased while the eradication rate steadily decreased for 5 years. However, there was no significant correlation between antibiotic use density and eradication. Conclusion There was no relationship between the eradication rate and antibiotic use density in Korea.

Current status of Helicobacter pylori eradication and risk factors for eradication failure

“…In this study, a significant trend of decreasing eradication rates was observed with increasing age, which is consistent with previous reports[ 27 , 28 ]. Possible reasons include lower tolerance to and compliance with therapy, more potential complications, increased risks of drug side effects, and increased antibiotic resistance because of higher accumulated antibiotic consumption[ 29 ].…”

Seven-day vonoprazan and low-dose amoxicillin dual therapy as first-lineHelicobacter pyloritreatment: a multicentre randomised trial in Japan

“…Standard triple therapy (STT) consisting of a PPI, AMO and CLA is no longer effective in many regions of the world owing to increasing CLA resistance of H. pylori ; four-drug combination therapy such as bismuth-containing quadruple therapy (BQT) or concomitant quadruple therapy (CQT) are currently recommended as first-line treatments in areas with high CLA resistance 6–8. In previous studies, the eradication rates ranged 55%–72% for STT in 7 days,16–18 80%–95% for BQT16 19–22 and 81%–90% for CQT17 23–26 as first-line H. pylori eradication treatments. The eradication rates of VA-dual and VAC-triple therapies in this study were higher than those previously reported for the 7-day STT and as high as the ones reported for BQT and CQT although the CLA resistance rate was 25% in this study.…”

Ten-day bismuth-containing quadruple therapy versus 7-day proton pump inhibitor-clarithromycin containing triple therapy as first-line empirical therapy for the Helicobacter pylori infection in Korea: a randomized open-label trial

“…In Korea, STT has been recommended as the first-line therapy since the H. pylori management guidelines were first reported in 1998 [ 3 – 5 ]. A study using a nationwide online registry of H. pylori eradication reported that STT was the most common first-line therapy prescribed (91.8%) in Korea from 2010 to 2015 [ 6 ]. However, because of the increased clarithromycin resistance (17.8%-45.9%) [ 7 , 8 ], two meta-analyses including the studies reported from 1998 to 2013 and a nationwide multicenter randomized study reported in 2019 showed that the eradication rates of STT have decreased to unacceptable levels (63.9–74.6%) in Korea [ 9 – 11 ].…”

“…The European and North American guidelines also recommended the BQT as an empiric first-line therapy in high clarithromycin resistant regions [ 1 , 2 ]. However, in the nationwide registry database, the prescription rate of BQT as first-line therapy in Korea was low (2.2%) [ 6 ]. The low prescription rate of the regimen as first-line therapy is related to the fact that the regimen is reserved for a second-line therapy after the first-line STT failure [ 5 ].…”

“…The low prescription rate of the regimen as first-line therapy is related to the fact that the regimen is reserved for a second-line therapy after the first-line STT failure [ 5 ]. The BQT accounts for up to 81% of all prescribed second-line therapies in Korea [ 6 ]. It also has a complex dosing schedule and higher risk of adverse events, which might affect compliance with the regimen [ 12 , 13 ].…”