S2088 An Estimation of Clarithromycin Resistance Among Hispanic Patients in Queens, New York: A Retrospective Study

Introduction: Helicobacter pylori is a Gram-negative bacteria which affects roughly half of the Latin American population. Untreated infections can lead to peptic ulcers, atrophic gastritis and gastric cancers. Current guidelines recommend quadruple therapy based on high global and US resistance rates, but regional data in New York City (NYC) is limited and local eradication rates are needed to guide treatment options. Methods: An EMR review was conducted for H. pylori positive Hispanic patients treated from January 2017 to January 2022 at a tertiary community hospital in Queens, NY. H. pylori positivity was defined by blood antibody tests, stool antigen tests, or histopathological diagnosis on gastric biopsy. Inclusion criteria required that all patients underwent clarithromycin based triple therapy for 2 weeks. Eradication was based on post-treatment stool antigen tests or biopsy results. As this was a Quality Improvement study, an internation review board approval was not obtained. Results: In total, 324 adult Hispanic patients of whom were prescribed clarithromycin based triple therapy, 239 completed treatment as prescribed, and 85 patients either did not take the medication or did not follow up to demonstrate eradication. After completion of triple therapy, H. pylori was eradicated in 187 (78.2%) treated patients. Conclusion: The current ACG guidelines recommend quadruple bismuth subsalicylate therapy over triple therapy based on 15% clarithromycin resistance rates across the U.S. However, H. pylori antibiotic susceptibility testing data is limited from the NYC area, with 1 study from the Bronx showing high clarithromycin resistance rates. Our H. pylori eradication rate of 78% is consistent with the overall 75% eradication rate reported in randomized trials, but below the 85% acceptable eradication rate by ACG. Until susceptibility testing is incorporated into the management of H. pylori, with regional antibiograms available, GI physicians will need to rely on surrogate US guidelines. While quadruple therapy is the recommended first line regimen, it is more complex and completion rates in the NYC area are also less known. Ideally, simplified alternative triple regimens utilizing potassium competitive acid blockers or Rifabutin therapy would improve medication adherence and tolerance, albeit at the harm of increasing costs. Further studies comparing compliance and eradication in triple and quadruple therapy versus the newer regimens would be beneficial in guiding treatment protocols to counter increased resistance rates in H. pylori.