Treatment of Helicobacter pylori Infection in Patients with Penicillin Allergy
Abstract
1. Introduction
2. Literature Search
3. Evidence for the Treatment of H. pylori Infection in Patients with Penicillin Allergy
Authors (Year, Country) | Study Design | Patient Characteristics | Treatment Regimens and Confirmatory Test for H. pylori Eradication |
---|---|---|---|
Zhang et al. (2022, China) [23] | RCT | Age: 18–75 years Penicillin allergy: not well defined Without previous eradication therapy Peptic ulcer: 15.8–19.4% | PBM1M2: R 10 mg BID + M2 100 mg BID + M1 400 mg TID + B 220 mg BID PBLM2: R 10 mg BID + M2 100 mg BID + L 400 mg QD + B 220 mg BID Duration: 14 days Confirmed: UBT at 4–12 weeks after treatment |
Tepes et al. (2021, Slovenia) [24] | Analysis of multicenter prospective registry | Age: 18–90 years Penicillin allergy: not well defined Without previous eradication therapy Peptic ulcer: N/A | PC1M1: E 40 mg BID + C1 500 mg BID + M1 400 mg TID Duration: 14 days Confirmed: UBT at least 4 weeks after treatment. |
Sue et al. (2021, Japan) [22] | Single-center, open-label, single-arm | Age: ≥20 years Penicillin allergy: diagnosis by a physician Failed first-line therapy Gastroduodenal ulcer: 23.5% | VM1S: V 20 mg BID + M1 250 mg BID + SF 100 mg BID Duration: 7 days Confirmed: UBT at 4 weeks after treatment |
Nyssen et al. (2020, European) [25] | Prospective registry of the clinical practice of European gastroenterologists (27 countries) | Age: Mean 53 ± 15 years Allergic to penicillin: not well defined With or without prior H pylori treatment Peptic ulcer: 17% | PC1M1: PPI + C1 + M PC1L: PPI + C1 + L PBTM1: PPI + B + T + M PM1L: PPI + M + L PC1LM1: PPI + C1 + L+ M Duration: N/A Confirmed: Locally accepted/validated diagnostic methods at least 4 weeks after treatment |
Gao et al. (2019, China) [26] | Retrospective | Age: 19–75 years Penicillin allergy: not well defined Without previous eradication therapy Peptic ulcer: 17.5% | PBTM1: LPZ 30 mg BID + B 150 mg TID + T 500 mg TID + M1 400 mg TID Duration: 14 days Confirmed: UBT at 4 weeks after treatment |
Song et al. (2019, China) [27] | Prospective single center | Age: 42.8 ± 13.7 years Penicillin allergy: well defined Without previous eradication therapy Peptic ulcer: 9.2% | Cefuroxime 500 mg BID + L 500 mg QD + E 20 mg BID + B 220 mg BID Duration: 14 days Confirmed: UBT at 8–12 weeks after treatment |
Long et al. (2018, China) [28] | Prospective, randomized, open-label, single-center | Age: 25–65 years Penicillin allergy: not well defined Without previous eradication therapy Peptic ulcer: 15.2% | PC1M1: E 20 mg BID + C1 500 mg BID + M1 400 mg QID BEC1M1: E 20 mg BID + C1 500 mg BID + M1 400 mg QID + B 600 mg BID Duration: 14 days Confirmed: UBT at 6 weeks after treatment |
Osumi et al. (2017, Japan) [29] | Retrospective | Age: 26–83 years Penicillin allergy: not well defined Unknown prior treatments Peptic ulcer: N/A | 20 mg R + 250 mg M1 + 100 mg M2 BID Duration: 7 days Confirmed: UBT at least 12 weeks after treatment |
Sue et al. (2017, Japan) [30] | Prospective study for vonoprazan, Retrospective for PPI | Age: ≥20 years Penicillin allergy: not well defined Without previous eradication therapy Peptic ulcer: 28% | VC1M1: V 20 mg + C1 200 or 400 mg + M1 250 mg BID PC1M1: PPI (30 mg BID LPZ or 20 mg BID E) + C1 200 or 400 mg BID + M1 750 mg BID Duration: 7 days Confirmed: UBT at least 4 weeks after treatment |
Mori et al. (2017, Japan) [31] | Prospective, single arm, nonrandomized | Age: ≥20 years Penicillin allergy: not well defined With or without prior treatment Peptic ulcer: 15.8% | PM1S: 20 mg E BID + 250 mg M1 BID + 100 mg SF BID Duration: 10 days Confirmed: UBT or HpSA at 12 weeks after treatment |
Ono et al. (2017, Japan) [32] | Retrospective | Age: mean 59 years Penicillin allergy: not well defined With or without prior treatment Peptic ulcer: 17.8% | PC1M1: C1 200 mg BID + M1 250 mg BID + LPZ 30 mg BID or R 20 mg BID VC1M1: C1 200 mg BID + M1 250 mg BID + V 20 mg BID PM1S: M1 250 mg BID + SF 100 mg BID + LPZ 30 mg BID or R 20 mg BID VSM1: M1 250 mg BID + SF 100 mg BID + V 20 mg BID Duration: 7 days Confirmed: UBT more than 8 weeks after treatment |
Segarra-Newnham et al. (2004, USA) [33] | Retrospective | Age: 29–84 years Penicillin allergy: not well defined Unknown prior treatments Peptic ulcer: N/A | PC1M1: M1 500 mg BID + C1 500 mg BID + PPI BID Duration: 7 days Confirmed: No information |
Parch et al. (1998, USA) [34] | Single-center, open, randomized, parallel | Age: 18–75 years Penicillin allergy: not well defined Unknown prior treatments Peptic ulcer: 100% | O 20 mg BID + C1 500 mg TID Duration: 7 days Confirmed: UBT at 4 weeks after treatment |
Gisbert et al. (2010, Spain) [35] | Prospective multicenter | Age: mean 51 ± 18 years Penicillin allergy: not well defined Without prior treatment, start PC1M1 first, if failed, start PC1L Peptic ulcer: 98% | PC1M1: O 20 mg BID + C1 500 mg BID + M1 500 mg BID for 7 days PC1L: O 20 mg BID + C1 500 mg + L 500 mg BID for 10 days. Duration: 7 days vs. 10 days Confirmed: UBT at 8 weeks after treatment |
Tay et al. (2012, Australia) [36] | Retrospective | Age: mean 16–85 years Penicillin allergy: not well defined Failed prior treatment Peptic ulcer: N/A | R 20 mg TID + B 240 mg QID + RFB 150 mg BID + C2 500 mg BID Duration: 10 days Confirmed: UBT at least 4 weeks after treatment |
Liang et al. (2013, China) [37] | Prospective, open label | Age: 18–79 years Penicillin allergy: not well defined Failed one or more prior treatments Peptic ulcer: N/A | N = 109, results reported for whole group including non-allergic PBTF: LPZ 30 mg BID + B 220 mg BID + T 500 mg TID + FZD 100 mg TID PBTM1: LPZ 30 mg BID + B 220 mg BID + T 500 mg QID + M1 400 mg QID Duration: 14 days Confirmed: UBT at 6 weeks after treatment |
Matsushima et al. (2006, Japan) [38] | Retrospective | Age: ≥18 years Penicillin allergy: not well defined Without prior treatment Peptic ulcer: N/A | PTM1: PPI (LPZ 30 mg, O 20 mg, or R 10 mg, QD) + T 500 mg BID + M1 250 mg BID Duration: 7–14 days Confirmed: UBT or by HP stool antigen at more than 2 months after therapy |
Gisbert et al. (2005, Spain) [39] | Prospective single center | Age: ≥18 years Penicillin allergy: not well defined With or without prior treatment Peptic ulcer: N/A | PC1M1: O 20 mg BID + C1 500 mg BID + M1 500 mg BID for 7 days BTM1: ranitidine bismuth citrate 400 mg BID + T 500 mg QID + M1 250 mg QID for 7 days PCR: RFB 150 mg BID + C1 500 mg BID + 3rd line O 20 mg BID for 10 days PC1L: L 500 mg BID + C1 500 mg BID + O 20 mg BID for 10 days Duration: 7 days or 10 days Confirmed: UBT at 8 weeks after treatment |
Rodriguez-torres et al. (2005, Puerto Rico) [40] | Prospective | Age: ≥21 years Penicillin allergy: not well defined With or without prior treatment Peptic ulcer: 0% | PM1T: E 40 mg + T 500 mg + M1 500 mg QID Duration: 14 days Confirmed: UBT at 4 weeks after treatment |
Gisbert et al. (2015, Spain) [41] | Prospective multicenter | Age: ≥21 years Penicillin allergy: not well defined With or without prior treatment Peptic ulcer: 9% | PC1M1: O 20 mg + C1 500 mg + M1 500 mg BID for 7 days. PBTM1: O 20 mg BID + B 120 mg QID + Oxytetracycline 500 mg QID or doxycycline 100 mg BID + M1 500 mg TID for 10 days PC1L: O 20 mg + C1 500 mg + L 500 mg BID for 10 days PC1R: O 20 mg BID + C1 500 mg BID + RFB 150 mg BID for 10 days Duration: 7–10 days Confirmed: UBT at 8 weeks after treatment |
Adachi et al. (2023, Japan) [20] | Retrospective | Age: > 18 years Penicillin allergy: self-reported With or without prior treatment Peptic ulcer: 3.8% | PC1M1: C1 200 mg BID + M1 250 mg BID + L 30 mg BID or R 20 mg BID or E 20 mg BID VC1M1: C1 200 mg BID + M1 250 mg BID + V 20 mg BID VM1S: M1 250 mg BID + STFX 50 mg BID + V 20 mg BID Duration: 7 days Confirmed: UBT 6 to 8 weeks after treatment |
Gao et al. (2023, China) [21] | Cross-sectional retrospective | Age: 18–69 years Penicillin allergy: well defined Without prior treatment Peptic ulcer: 33.8% | V 20 mg BID + T 500 mg TID (body weight < 70 kg) or QID (body weigh ≥ 70 kg) Duration: 14 days Confirmed: UBT at least 6 weeks after therapy |
3.1. Vonoprazan-Based Therapy
3.1.1. Vonoprazan-Clarithromycin-Metronidazole (VC1M1) Therapy
3.1.2. Vonoprazan-Sitafloxacin-Metronidazole (VSM1) Therapy
3.1.3. Vonoprazan-Tetracycline Therapy
Authors (Year, Country) | Treatment Status | N | Eradication Rate | Adverse Events | Adherence | |
---|---|---|---|---|---|---|
ITT | PP | |||||
Vonoprazan-Clarithromycin-Metronidazole (VC1M1) | ||||||
Sue et al. (2017, Japan) [30] | First-line | 20 | 100% | 100% | Diarrhea (5.0%) Nausea (15%) Abdominal pain (15%) Abdominal fullness (30%) General malaise (15%) Headache (10%) | 100% |
Ono et al. (2017, Japan) [32] | First-line | 13 | 92.3% | 92.3% | Severe adverse events (0%) | N/A |
Ono et al. (2017, Japan) [32] | Second-line | 1 | 100% | 100% | Severe adverse events (0%) | N/A |
Adachi et al. (2023, Japan) [20] | Not clear | 35 | 94.3% CAM-R (90%) CAM-S (100%) | 100% CAM-R (100%) CAM-S (100%) | 8.6% | 97.1% |
Vonoprazan-Sitafloxacin-Metronidazole (VSM1) | ||||||
Ono et al. (2017, Japan) [32] | First-line | 14 | 92.9% | 100% | Severe adverse events (5.9%) | N/A |
Ono et al. (2017, Japan) [32] | Second-line | 3 | 66.7% | 66.7% | N/A | |
Adachi et al. (2023, Japan) [20] | Not clear | 10 | 90% | 90% | 20% | 100% |
Sue et al. (2021, Japan) [22] | Second- or later-line | 17 | 88.2% | 88.2% | Diarrhea (50.0%) Dysgeusia (6.3%) Nausea (6.3%) Abdominal pain (31.3%) Headache (12.5%) Abdominal fullness (50.0%) General malaise (12.5%) Hives (25.0%) Belching (25.0%) | 100% |
Vonoprazan-Tetracycline (VT) | ||||||
Gao et al. (2023, China) [21] | First-line | 18 | 100% | N/A | Total (27.8%) Nausea (5.6%) Skin rash (5.6%) Fatigue (5.6%) Abdominal pain (11.2%) | 94.40% |
3.2. PPI-Based Therapies
3.2.1. PPI Clarithromycin Dual Therapy
3.2.2. PPI-Based Triple Therapy
PPI-Clarithromycin-Metronidazole (PC1M1) Therapy
3.2.3. PPI-Metronidazole-Tetracycline (PM1T) Therapy
3.2.4. PCL: PPI-Clarithromycin-Levofloxacin (PC1L) Therapy
3.2.5. PPI-Metronidazole-Levofloxacin (PM1L) Therapy
3.2.6. PPI-Metronidazole-Sitafloxacin (PM1S) Therapy
3.2.7. PPI-Clarithromycin-Rifabutin (PC1R) Therapy
3.2.8. PPI-Metronidazole-Minocycline (PM1M2) Therapy
3.3. PPI-Clarithromycin-Metronidazole-Levofloxacin (PC1M1L) Therapy
Authors (Year, Country) | Treatment Status | N | Eradication Rate | Adverse Events | Adherence | |
---|---|---|---|---|---|---|
ITT | PP | |||||
PPI-Clarithromycin-Metronidazole (PC1M1) | ||||||
Tepes et al. (2021, Slovenia) [24] | First-line | 35 | 83% | 83% | N/A | N/A |
Long et al. (2018, China) [28] | First-line | 33 | 63.6% | 70% | 45.5% | 93.9% |
Sue et al. (2017, Japan) [30] | First-line | 30 | 83.3% | 82.7% | Diarrhea (6.7%) Abdominal pain (3.3%) Abdominal fullness (3.3%) General malaise (3.3%) | 100% |
Gisbert et al. (2015, Spain) [41] | First-line | 112 | 57% | 59% | 14% | 94% |
Gisbert et al. (2010, Spain) [35] | First-line | 50 | 54% | 55% | 10% | 98% |
Gisbert et al. (2005, Spain) [39] | First-line | 12 | 58% | 64% | 17% | 92% |
Nyssen et al. (2020, Europe) [25] | First-line | 228 | 69% | 69% | 23% | 98% |
Ono et al. (2017, Japan) [32] | First-line | 10 | 50% | 55.6% | 7.7% | N/A |
Ono et al. (2017, Japan) [32] | Second-line | 3 | 33.3% | 33.3% | 7.7% | N/A |
Segarra-Newnham et al. (2004, USA) [33] | Unknown | 22 | N/A | 91% | N/A | N/A |
Adachi et al. (2023, Japan) [20] | Unknown | 8 | 50% | 50% | 12.5% | 100% |
PPI-Metronidazole-Tetracycline (PM1T) | ||||||
Matsushima et al. (2006, Japan) [38] | First-line | 5 | 80% | 100% | N/A | N/A |
Rodriguez-torres et al. (2005, Puerto Rico) [40] | First-line | 17 | 84% | N/A | 55% | 80% |
Rodriguez-torres et al. (2005, Puerto Rico) [40] | Second-line | 3 | 100% | N/A | ||
PPI-Clarithromycin-Levofloxacin (PC1L) | ||||||
Nyssen et al. (2020, Europe) [25] | First-line | 50 | 80% | 82% | 19% | 98% |
Gisbert et al. (2010, Spain) [35] | Second-line | 15 | 73% | 73% | 20% | 100% |
Nyssen et al. (2020, Europe) [25] | Second-line, failed PC1M1 | 17 | 71% | 69% | 16% | 89.5% |
Gisbert et al. (2015, Spain) [41] | Second-line, failed PC1M1 | 50 | 64% | 73% | 23% | 88% |
Nyssen et al. (2020, Europe) [25] | Second-line, failed PBTM1 | 3 | 100% | 100% | 50% | 75% |
Gisbert et al. (2015, Spain) [41] | Second-line, failed PBTM1 | 14 | 64% | 64% | 29% | 100% |
Nyssen et al. (2020, Europe) [25] | Third-line | 2 | 50% | 50% | 0% | 100% |
Gisbert et al. (2015, Spain) [41] | Third-line | 3 | 33% | 50% | 67% | 67% |
Gisbert et al. (2015, Spain) [41] | Fourth-line | 2 | 100% | 100% | 67% | 100% |
Gisbert et al. (2005, Spain) [39] | Fourth-line | 2 | 100% | 100% | 50% | 100% |
PPI-Metronidazole-Levofloxacin (PM1L) | ||||||
Nyssen et al. (2020, Europe) [25] | Second-line, failed PC1M1 | 13 | 77% | 77% | 23% | 100% |
Nyssen et al. (2020, Europe) [25] | Second-line, failed PBTM1 | 4 | 75% | 75% | 0% | 100% |
PPI-Metronidazole-Sitafloxacin (PM1S) | ||||||
Ono et al. (2017, Japan) [32] | First-line | 20 | 100% | 100% | Severe adverse events (2.3%) | N/A |
Mori et al. (2017, Japan) [31] | First-line | 33 | 100% | N/A | Total (31.6%) Soft stool (12.3%) Diarrhea (7.0%) Dysgeusia (7.0%) Stomatitis (5.3%) Itching (5.3%) Skin rash (3.5%) Abdominal pain (1.8%) Headache (1.8%) | 100% |
Mori et al. (2017, Japan) [31] | Second-line | 19 | 84.2% | N/A | ||
Mori et al. (2017, Japan) [31] | Third-line | 5 | 40% | N/A | ||
Ono et al. (2017, Japan) [32] | Second-line | 24 | 100% | 100% | Severe adverse events (2.3%) | N/A |
PPI-Clarithromycin-Rifabutin (PC1R) | ||||||
Gisbert et al. (2005, Spain) [39] | Third-line | 9 | 11% | 17% | 89% | 67% |
Gisbert et al. (2015, Spain) [41] | Third-line | 7 | 14% | 20% | 71% | 71% |
Gisbert et al. (2015, Spain) [41] | Fourth-line | 2 | 50% | 0% | 100% | 100% |
PPI-Metronidazole-Minocycline (PM1M2) | ||||||
Osumi et al. (2017, Japan) [29] | Unknown | 5 | 100% | N/A | N/A | N/A |
3.4. Bismuth-Based Therapy
3.4.1. Traditional PPI-Bismuth-Tetracycline-Metronidazole (PBTM1)
3.4.2. Modified Bismuth Quadruple Therapies
Minocycline Containing Therapy
PPI-Bismuth-Clarithromycin-Metronidazole (PBCM1)
PPI-Bismuth-Rifabutin-Ciprofloxacin (PBRC2)
PPI-Bismuth-Tetracycline-Furazolidone (PBTF)
Authors (Year and Country) | Treatment Status | N | Eradication Rate | Adverse Events | Adherence | |
---|---|---|---|---|---|---|
ITT | PP | |||||
Classic PPI-Bismuth-Tetracycline-Metronidazole (PBTM1) | ||||||
Nyssen et al. (2020, Europe) [25] | First-line | 228 | 91% | 92% | 29% | 96% |
Gao et al. (2019, China) [26] | First-line | 112 | 86.7% | 94.5% | 46.7% | 83.3% |
Gisbert et al. (2015, Spain) [41] | First-line | 50 | 74% | 75% | 14% | 98% |
Nyssen et al. (2020, Europe) [25] | Second-line, failed PC1M1 | 64 | 78% | 82% | 34% | 95.30% |
Nyssen et al. (2020, Europe) [25] | Second-line, failed PC1L | 5 | 80% | 80% | 20% | 100% |
Gisbert et al. (2015, Spain) [41] | Second-line | 24 | 37% | 38% | 58% | 87% |
Liang et al. (2013, China) [37] | Second- or later-line | Unknown | 87.9% | 93.1% | 33.6% | 94.4% |
Gisbert et al. (2015, Spain) [41] | Third-line | 3 | 100% | 100% | 67% | 100% |
Nyssen et al. (2020, Europe) [25] | Third-line, failed PC1M1, PC1L | 12 | 75% | 82% | 58% | 92% |
Nyssen et al. (2020, Europe) [25] | Third-line, failed PC1M1, PM1L | 5 | 100% | 100% | 0% | 100% |
Nyssen et al. (2020, Europe) [25] | Third-line, failed PC1L, PBTM1 | 1 | 0% | 0% | 0% | 100% |
Modified bismuth quadruple therapy | ||||||
PPI-Bismuth-Levofloxacin-Minocycline (PBLM2) | ||||||
Zhang et al. (2022, China) [23] | First-line | 74 | 89.2% | 90.4% | Total (33.8%), Nausea (4.1%) Abdominal discomfort (12.2%) Dizziness (20.3%) Diarrhea (5.4%) | ≥90% |
PPI-Bismuth-Metronidazole-Minocycline (PBM1M2) | ||||||
Zhang et al. (2022, China) [23] | First-line | 76 | 80.3% | 83.6% | Total (47.4%) Nausea (15.8%); Abdominal discomfort (32.9%); Dizziness (23.7%); Diarrhea (10.5%) | ≥90% |
PPI-Bismuth-Clarithromycin-Metronidazole (PBC1M1) | ||||||
Long et al. (2018, China) [28] | First-line | 33 | 84.8% | 96% | 48.5% | 81.8% |
PPI-Bismuth-Rifabutin-Ciprofloxacin (PBRC2) | ||||||
Tay et al. (2012, Australia) [36] | Second- or later-line | 69 | N/A | 94.2% | N/A | N/A |
PPI-Bismuth-Tetracycline-Furazolidone (PBTF) | ||||||
Liang et al. (2013, China) [37] | Second- or later-line | Unknown | 91.7% | 96.1% | 17.6% | 95.4% |
4. Discussion and Recommendations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Liu, L.; Nahata, M.C. Treatment of Helicobacter pylori Infection in Patients with Penicillin Allergy. Antibiotics 2023, 12, 737. https://doi.org/10.3390/antibiotics12040737
Liu L, Nahata MC. Treatment of Helicobacter pylori Infection in Patients with Penicillin Allergy. Antibiotics. 2023; 12(4):737. https://doi.org/10.3390/antibiotics12040737
Chicago/Turabian StyleLiu, Ligang, and Milap C. Nahata. 2023. "Treatment of Helicobacter pylori Infection in Patients with Penicillin Allergy" Antibiotics 12, no. 4: 737. https://doi.org/10.3390/antibiotics12040737
APA StyleLiu, L., & Nahata, M. C. (2023). Treatment of Helicobacter pylori Infection in Patients with Penicillin Allergy. Antibiotics, 12(4), 737. https://doi.org/10.3390/antibiotics12040737