Helicobacter pylori eradication therapy: a discrepancy between current guidelines and clinical practice.


BACKGROUND Consensus guidelines recommend that patients with peptic ulcer disease, and other causes of dyspepsia, should be treated with Helicobacter pylori eradication regimens. However, it has not been firmly established whether physicians have adapted their practice accordingly. OBJECTIVES (1) To establish the proportion of ulcer-healing prescriptions that H. pylori eradication regimens accounted for, (2) to evaluate the composition of the eradication regimens used, and (3) to compare the prescribing patterns of specialist and primary care practitioners. METHODS Seven community pharmacy practices were identified, and all prescriptions for individual acid-suppressing agents and eradication regimens were prospectively evaluated over an initial one-month period. Prospective documentation and evaluation of eradication regimens only was then continued for a further three-month period. RESULTS The prescriptions for 585 patients were evaluated. Proton-pump inhibitors and H2-receptor antagonists accounted for 261 (44.5%) and 307 (52.5%) of prescriptions respectively. H. pylori eradication therapy was prescribed for 17 (2.9%) patients in this initial period. Sixty-six eradication regimens were evaluated over four months: 48/66 (73%) of these were initiated by primary care practitioners and 18/66 (27%) by specialists. Thirteen different combinations of antibiotics and acid-suppressing agents were identified - many of undocumented efficacy. Dual, triple and quadruple regimens accounted for 15 (23%), 48 (72.5%) and 3 (4.5%) of patient prescriptions respectively. CONCLUSION H. pylori eradication therapy currently accounts for a very small proportion of ulcer-healing medication in clinical practice. Most eradication regimens are initiated by primary care practitioners. In comparison with specialist practices, prescriptions from this source are more likely to be of undocumented efficacy.


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