Helicobacter pylori first‐line and rescue treatments in patients allergic to penicillin: Experience from the European Registry on H pylori management (Hp‐EuReg)

Background Experience in Helicobacter pylori eradication treatment of patients allergic to penicillin is very scarce. A triple combination with a PPI, clarithromycin (C), and metronidazole (M) is often prescribed as the first option, although more recently the use of a quadruple therapy with PPI, bismuth (B), tetracycline (T), and M has been recommended. Aim To evaluate the efficacy and safety of first‐line and rescue treatments in patients allergic to penicillin in the “European Registry of H pylori management” (Hp‐EuReg). Methods A systematic prospective registry of the clinical practice of European gastroenterologists (27 countries, 300 investigators) on the management of H pylori infection. An e‐CRF was created on AEG‐REDCap. Patients with penicillin allergy were analyzed until June 2019. Results One‐thousand eighty‐four patients allergic to penicillin were analyzed. The most frequently prescribed first‐line treatments were as follows: PPI + C + M (n = 285) and PPI + B + T + M (classic or Pylera®; n = 250). In first line, the efficacy of PPI + C + M was 69%, while PPI + B + T + M reached 91% (P .05). In third line, after the failure of PPI + C + M and PPI + C + L, PPI + B + T + M was successful in 75% of cases. Conclusion In patients allergic to penicillin, a triple combination with PPI + C + M should not be generally recommended as a first‐line treatment, while a quadruple regimen with PPI + B + T + M seems to be a better option. As a rescue treatment, this quadruple regimen (if not previously prescribed) or a triple regimen with PPI + C + L could be used but achieved suboptimal (