First-line eradication regimens in penicillin-allergic patients in Andalusia. Results from the European Registry HP-EuReg in the 2013–2025 period.
Year: 2026
Type: article
Study design: Observational Study
Abstract: Introduction and aims: Eradication treatment of Helicobacter pylori (HP) infection remains a challenge in patients allergic to penicillin, particularly in areas with high clarithromycin resistance rates such as Andalusia (close to 20%). Therefore, our objective was to analyze the evolution of first-line regimens in penicillin-allergic naïve patients, assessing effectiveness, safety, and adherence. Materials and methods: A descriptive observational study based on the Hp-EuReg registry was conducted. Penicillin-allergic patients receiving first-line treatment between 2013 and 2025 in eleven centers in Andalusia were included. Demographic, clinical, and treatment-related variables were analyzed. Effectiveness was assessed using a modified intention-to-treat analysis. Results: Of 5,942 registered patients, 247 (4.2%) were naïve and allergic to penicillin. The most frequently used regimen was single-capsule bismuth quadruple therapy (Pylera®) (61.8%), followed by triple therapies (29.7%). Pylera achieved an eradication rate of 93.9%, significantly higher than that of triple therapies (p<0.001). The standard dose of proton pump inhibitors (PPI) was the most commonly prescribed, and the most frequent treatment duration was 10 days; however, neither variable reached statistical significance in terms of effectiveness. Overall adherence was optimal (97.1%), and the incidence of adverse events was low (≈9%), predominantly mild. Conclusion: Pylera® has become established as the most effective and safe first-line strategy in penicillin-allergic naïve patients, reflecting appropriate adaptation of clinical practice in Andalusia to the available scientific evidence. Abbreviations: Helicobacter pylori (HP), proton pump inhibitor (PPI), mucosa-associated lymphoid tissue lymphoma (MALT), intention-to-treat analysis (ITT), modified intention-to-treat analysis (mITT).
DOI: 10.37352/2026493.1
Authors: C Torres Blanco, A Pérez Aisa, F De la Cruz Romero, F Rivas Ruíz, M Pabón Carrasco, C Rodriguez Alonso, BJ Gómez Rodríguez, D Ledro Cano, A Keko Huerga, MC Perona Vicenti, S Jiménez Contreras, FJ Rodríguez González, SJ Martínez Domínguez, A Singla, O Farrés, P Parra, L Moreira, OP Nyssen, JP Gisbert
Institutions: Hospital Costa del Sol, Hospital Universitario de Valme, Hospital Universitario Virgen Macarena, Hospital Clínico Universitario Virgen de la Victoria, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria Aragón, Althaia, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Hospital Clínic de Barcelona, Consorci Institut D'Investigacions Biomediques August Pi I Sunyer, Universitat de Barcelona
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7166649827
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