Helicobacter Pylori First-Line and Rescue Treatments in the Presence of Penicillin Allergy

Background Helicobacter pylori eradication is a challenge in penicillin allergy. Aim To assess the efficacy and safety of first-line and rescue treatments in patients allergic to penicillin. Methods Prospective multicenter study. Patients allergic to penicillin were given a first-line treatment comprising (a) 7-day omeprazole–clarithromycin–metronidazole and (b) 10-day omeprazole–bismuth–tetracycline–metronidazole. Rescue treatments were as follows: (a) bismuth quadruple therapy; (b) 10-day PPI–clarithromycin–levofloxacin; and (c) 10-day PPI–clarithromycin–rifabutin. Eradication was confirmed by 13 C-urea breath test. Compliance was determined through questioning and recovery of empty medication envelopes. Adverse effects were evaluated by questionnaires. Results In total, 267 consecutive treatments were included. (1) First-line treatment: Per-protocol and intention-to-treat eradication rates with omeprazole–clarithromycin–metronidazole were 59 % (62/105; 95 % CI 49–62 %) and 57 % (64/112; 95 % CI 47–67 %). Respective figures for PPI–bismuth–tetracycline–metronidazole were 75 % (37/49; 95 % CI 62–89 %) and 74 % (37/50; 95 % CI (61–87 %) ( p