Factors associated with treatment outcome of Helicobacter Pylori among Dyspeptic patients using Clarithromycin based therapy at Muhimbili National Hospital

Abstract

ABSTRACT Background: Helicobacter pylori affects 50 % of the world population, the highest rate of infections seen in developing nations due to poor socioeconomic status and subpar medical services. Although treatment has been available for more than 2 decades, currently failure of treatment with the standard regimen has been noticed. Several factors are seen attributed to the treatment failure, including but not limited to, antibiotic resistance, socio-economic status, diet and many more. Few studies have been done in Africa, and fewer in East Africa to determine the factors that influence treatment outcome of H. pylori infection. Objectives: To determine the factors associated with treatment outcome of H. pylori infection with clarithromycin-based therapy among dyspeptic patients at MNH Upanga Methodology: A cross-sectional study at the Endoscopy unit at MNH Upanga was conducted between July 2022 to February 2023. All dyspeptic patients with stool antigen positive for H. pylori were given first line therapy (metronidazole, clarithromycin and PPI), and stool antigen was repeated 6 weeks after completion of the treatment. Biopsies were taken among those with positive stool antigen for H. pylori after 6 weeks and culture and AST was done. Data of socio demographics, endoscopy results, adherence to treatment, previous treatment with triple therapy and failure to eradicate H. pylori was tested for after 6 weeks follow up were documented. SPSS version 23 was used for data analysis with statistically significant association from a p-value <0.05. Results: Cumulatively 385 patients with stool antigen for H. pylori were enrolled; mean age (±SD) was 41 (±14) years. Females were more than half of the patients 213 (55.3%), 171 (44.4%) were college graduates, and approximately half of the patients were self-employed 178 (46.2%). Only 11 (3%) were currently smoking, one third reported alcohol use 149 (38.7%). First line treatment failure as defined positive stool antigen 6 weeks post treatment was observed in 132 (38.3%) of patients. Independent predictors of first line treatment failure were smoking (OR:7.9, 95%CI (0.93 – 6.7), P = 0.03), concomitant herbal medication (OR:6.7, 95%CI (3.9 – 11.6), P <0.001), endoscopy findings (OR:1.7, 95%CI (0.61 – 3.71), P =0.48) and adherence to treatment (OR:6.2, 95%CI (3.52 – 10.8), P<0.001). From 130 patients 86 (66.15%) were inoculated and AST was done, antibiotic resistant patterns were 30% amoxicillin, 62.8% metronidazole, 30% and for clarithromycin. Conclusion: About one third of patients showed no eradication from clarithromycin- based therapy which is usually the first line used. This is below the guideline recommended value. Poor adherence, concurrent use of herbal medication and cigarette smoking were seen as significant causes of poor eradication of H. pylori eradication. The resistance to all medication used as first line in the management of H. pylori are still staggeringly high. Treatment pf H. pylori infection should be individualized per patient as not all patients will respond to the same regimen due to increased antibiotic resistance.