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Eradication Rates of Empiric Helicobacter pylori Treatment Regimens by Race/Ethnicity in a Predominantly Immigrant U.S. Population

Kim MJ, Gonzalez I, Choi NM, Graham DY, El-Serag HB, Tan MC

Helicobacter, 2025

Abstract

BACKGROUND: Helicobacter pylori infections are mostly treated empirically (without antibiotic susceptibility testing). Determining eradication rates of different treatment regimens can inform antibiotic resistance. Our aim was to examine eradication rates of empiric H. pylori treatments based on treatment regimen, race/ethnicity and previous treatment status in a multiethnic U.S.

MATERIALS AND METHODS: This was a retrospective cross-sectional study of patients with a positive H. pylori test from 7/2021 to 4/2022 at Harris Health (Houston, Texas) who had received treatment and eradication testing within 1 year. We compared eradication rates based on treatment regimen, race/ethnicity, and prior treatment and examined other possible risk factors for treatment failure using logistic regression models.

RESULTS: Among 1106 H. pylori-infected patients, 29.2% were male, 80.6% Hispanic, 10.7% black, 2.5% white, and 83.3% were non-U.S. born with a mean age of 50.8 years (standard deviation 12.6). Most patients (57.3%) received bismuth-tetracycline-metronidazole quadruple, 21.2% clarithromycin-metronidazole-amoxicillin quadruple, 15.6% clarithromycin-amoxicillin triple, and 3.9% received clarithromycin-metronidazole triple therapies. Eradication rates were highest for bismuth-tetracycline-metronidazole quadruple (83.8%), clarithromycin-metronidazole-amoxicillin quadruple (80.3%), and clarithromycin-amoxicillin triple therapies (79.2%). In 186 (16.8%) previously treated patients, all…

How strong is the evidence?

Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause.

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