P1344 - Hispanic Patients Experience Higher Rates of Treatment Failure of Helicobacter pylori on Levofloxacin-Based Regimen

Alejandro A. Rodriguez, MD, MS¹, Frank Cusimano, DO, PhD¹, Neelima Gaddipati, MD, MBA², Valerie S.. Stark, BS³, Brooke I.. Buonocore, BS⁴, Gala Godoy Brewer, MD¹, Alana Moore, BS⁵, Aidan Scagel, BS⁴, Diana M. Mosquera, MS, MD⁶, Shida Haghighat, MD, MPH⁷, Ami Panara Shukla, MD^1
1University of Miami/Jackson Memorial Hospital, Miami, FL; ²Jackson Health System, University of Miami, Miami, FL; ³University of Miami Miller School of Medicine, Miami Beach, FL; ⁴University of Miami Miller School of Medicine, Miami, FL; ⁵University of Miami, Boynton Beach, FL; ⁶University of Miami, Jackson Memorial Hospital, Miami, FL; ⁷University of Miami, Miami, FL

Introduction: Antimicrobial resistance is an ever growing threat in the treatment of Helicobacter pylori infection. There is an overall paucity of data on the rate of eradication and local resistance in the USA. Current treatment recommendations may not adequately capture rapidly shifting and regional trends in antibiotic resistance that affect treatment efficacy, presenting a unique challenge to urban centers with ethnically diverse and high immigrant populations. This study investigated the rate of H. pylori eradication in a Miami-based cohort with different treatment regimens.

Methods: Adult patients at our institution diagnosed with H. pylori infection who were treated and underwent eradication testing from 2014 - 2020 were included in this retrospective cohort study.

Results: Overall, 627 patients with H. pylori were treated and underwent eradication testing (65% female, 66% Hispanic ethnicity). The most commonly prescribed treatment regimens were clarithromycin-based (461, 73%), bismuth-based (65, 10%) and levofloxacin-based (52, 8.3%). For these three regimens, the cumulative eradication rate was 69%. There was no statistically significant association between rate of eradication and chosen treatment regimen in the overall cohort. There was also no association between eradication rate and ethnicity for the overall cohort. However, for the Hispanic subgroup, the choice of levofloxacin-based therapy was associated with a significantly lower rate of eradication 46% when compared to bismuth-based therapy (67%) or clarithromycin-based (72%) therapy (p=0.006).

Discussion: The literature on H. pylori eradication demonstrates an inverse relationship between rising antibiotic resistance and decreasing eradication rates. There is evidence to suggest that levofloxacin resistance is particularly high in the Americas (Latin America 15%, USA 37%) compared to Europe (14%) and Asia (11%). In our cohort, we saw a cumulative eradication rate well below the goal of >80% and a trend towards decreased eradication rate with levofloxacin-based regimen, which was statistically significant for Hispanic patients. Our study demonstrates that levofloxacin-based regimen may be an ineffective choice for eradication therapy and underscores the significant need for local antibiotic resistance data guiding treatment regimens.



Disclosures:


Alejandro A. Rodriguez, MD, MS¹, Frank Cusimano, DO, PhD¹, Neelima Gaddipati, MD, MBA², Valerie S.. Stark, BS³, Brooke I.. Buonocore, BS⁴, Gala Godoy Brewer, MD¹, Alana Moore, BS⁵, Aidan Scagel, BS⁴, Diana M. Mosquera, MS, MD⁶, Shida Haghighat, MD, MPH⁷, Ami Panara Shukla, MD¹. P1344 - Hispanic Patients Experience Higher Rates of Treatment Failure of Helicobacter pylori on Levofloxacin-Based Regimen, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.