Lack of Usefulness of Literature‐Based Helicobacter pylori Resistance Data for Predicting First‐Line Empirical Treatment Effectiveness in the European Registry on H. pylori
Ismail Kirrout, Olga P. Nyssen, Ángeles Pérez‐Aísa, Bojan Tepes, Irina N. Voynovan, Samuel J. Martínez‐Domínguez, Alfredo J. Lucendo, Ludmila G. Vologzanina, Matteo Pavoni, Sayar R. Abdulkhakov, Maja Denkovski, Javier Tejedor‐Tejada, Tatiana Ilchishina, Luis Bujanda, Aiman S. Sarsenbaeva, Jose M. Huguet, Oleg Zaytsev, Boris D. Starostin, Monica Perona, Antonietta G. Gravina, Manuel Pabón‐Carrasco, Sergey A. Alekseenko, Óscar Núñez, Miguel Areia, Jesús Barrio, Antonio Moreno Loro, Dmitry N. Andreev, Blas José Gómez Rodríguez, María Soledad Marcos, Inmaculada Ortiz‐Polo, Galina N. Tarasova, Igor Bakulin, Mónica Sánchez Alonso, Irene Arteagoitia, Virginia Flores, Manuel Jiménez‐Moreno, Dmitry S. Bordin, Antonio Gasbarrini, Ricardo Marcos‐Pinto, Wojciech Marlicz, Perminder S. Phull, Marino Venerito, Doron Boltin, Lyudmila Boyanova, Pablo Parra, Leticia Moreira, Francis Mégraud, Colm O'Morain, Nuria Montes, Javier P. Gisbert,ABSTRACT
Background
Objective
To evaluate whether literature‐based resistance data could predict first‐line empirical treatment effectiveness.
Methods
Resistance rates for clarithromycin, metronidazole, and levofloxacin were extracted from bibliographic reviews and estimated for three timeframes: the treatment year, the preceding year, and the last five years average. These rates (2008–2024) were matched with outcomes from the European Registry on
Results
Analysis included 37,659 patients receiving first‐line empirical treatment from 13 countries. Moderate negative correlations were observed between metronidazole and clarithromycin resistances for some regimens. In the regression model, including either contemporaneous or previous‐year resistance rates, clarithromycin resistance showed a negligible positive association, while metronidazole resistance was negatively associated. In regimen‐specific models, previous‐year clarithromycin resistance was positively associated with success in concomitant therapy, whereas higher five‐year mean clarithromycin resistance reduced eradication odds in quadruple clarithromycin–amoxicillin–bismuth therapy. Random Forest models identified compliance, proton‐pump inhibitor dose, regimen duration, and treatment as the strongest predictors of eradication, while resistance variables contributed minimally.
Conclusion
Literature‐based resistance data are not useful for guiding real‐world first‐line
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