# Helicobacter pylori eradication rate following first line non-bismuth quadruple therapy regimen in Tunisian patients: the HPERAD study

## TL;DR

This study found that non-bismuth quadruple therapy for Helicobacter pylori in Tunisia had an 88.2% success rate, mainly affected by antibiotic resistance and female gender.

## Contribution

The study provides updated eradication rates and identifies key predictors of treatment failure in a Tunisian population.

## Key findings

- The eradication rate was 88.2% using non-bismuth quadruple therapy.
- Clarithromycin resistance and female gender were significant predictors of treatment failure.
- Adverse effects occurred in 34.5% of patients during treatment.

## Abstract

Helicobacter pylori (H. pylori) eradication is a continuously challenging issue as antibiotic resistance is evolving and adversely affecting outcomes of previously effective treatments. Continual assessment and modification of therapeutic approaches is necessary.

The aim of our study was to evaluate H. pylori eradication rate in Tunisian patients treated by non-bismuth quadruple therapy and to investigate treatment failure factors.

We conducted a prospective multicentric study including patients with H. pylori infection. For all patients, concomitant therapy (amoxicillin 1 g, clarithromycin 500 mg and metronidazole 500 mg plus esomeprazole 40 mg) twice daily for 14 days was prescribed. Mutations conferring resistance of H. pylori to clarithromycin were detected using polymerase chain reaction on gastric biopsies. Eradication was assessed using the urea breath test.

414 patients were included. The mean age was 44.7 ± 14.3 with a sex ratio of M/F = 0.53. Mutations conferring resistance of H. pylori to clarithromycin were observed in 76 patients (18.35%). During follow-up, adverse effects to treatment occurred in 34.5% of patients. Eradication rate was 88.2% (95% CI: [85.1–91.3]) in per protocol analysis. In multivariate analysis, female gender (OR:2.924, 95% CI (1.340–6.380), p = 0.009) and the presence of clarithromycin resistance gene (OR:4.671, 95% CI (2.444–8.925), p < 0.001) were predictors of treatment failure.

Concomitant therapy showed an eradication rate below 90% in Tunisian patients, mainly due to clarithromycin resistance and female gender. However, non-bismuth quadruple therapy remains a viable alternative option, achieving eradication in more than 8 out of 10 patients.

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