AUTHOR=Choe Younghee , Kim Joon Sung , Choi Hyun Ho , Kim Dae Bum , Park Jae Myung , Oh Jung Hwan , Kim Tae Ho , Cheung Dae Young , Chung Woo Chul , Kim Byung-Wook , Kim Sung Soo
TITLE=The Influence of Past Metronidazole Exposure on the Outcome of Helicobacter pylori Eradication
JOURNAL=Frontiers in Microbiology
VOLUME=13
YEAR=2022
URL=https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2022.857569
DOI=10.3389/fmicb.2022.857569
ISSN=1664-302X
ABSTRACT=BackgroundBismuth quadruple therapy (BQT) is recommended as empirical first-line therapy because it is not affected by antibiotic resistance. We examined whether past exposure to metronidazole affected BQT outcomes.
MethodsThe records of seven hospitals were searched for patients who received BQT for Helicobacter pylori eradication between 2009 and 2020. The association between past metronidazole exposure and the eradication rate was evaluated.
ResultsThis study was a multicenter retrospective study. Around 37,602 people tested for H. pylori infection were identified, and 7,233 received BQT. About 2,802 (38.7%) underwent a 13C-urea breath test to confirm eradication. The BQT efficacy was 86.4% among patients without metronidazole exposure and 72.8% among patients with exposure (p < 0.001). The eradication rate of BQT 14 days in patients with past exposure was higher than that of BQT <14 days (85.5 vs. 66.0%, p = 0.009). Multivariate analysis revealed that past metronidazole exposure [odds ratio (OR) 2.6, 95% CI 1.8–3.7; p < 0.001] and BQT <14 days (OR 1.5, 95% CI 1.2–2.0; p = 0.002) were independent risk factors for eradication failure.
ConclusionPast metronidazole exposure significantly lowered the BQT eradication rate. BQT 14 days should be recommended for patients with suspected metronidazole exposure.