Table 3.
Risk factors for eradication failure of tailored triple therapy (TTT) among treatment naïve patients (group A), N = 503
| Factors, n (row percent %) | N | ER failed n (%) |
ER success n (%) |
p valuea | ORcrudeb (95% CI) | p valuec | ORadjd (95% CI) | p valuec |
|---|---|---|---|---|---|---|---|---|
| Gender | 0.520 | |||||||
| Female | 268 | 25 (9%) | 243 (91%) | Ref | ||||
| Male | 235 | 26 (11%) | 209 (89%) | 1.21 (0.68–2.16) | 0.520 | |||
| Age (years), median (IQR) | 503 | 13 (11–15) | 13 (10–15) | 0.871 | 1.03 (0.94–1.13) | 0.546 | ||
| Country of livinge | 0.288 | |||||||
| Northern/Western Europe | 146 | 11 (8%) | 135 (92%) | Ref | ||||
| Southern Europe | 222 | 21 (9%) | 201 (91%) | 1.28 (0.60–2.75) | 0.522 | |||
| Eastern Europe | 113 | 16 (14%) | 97 (86%) | 2.02 (0.90–4.55) | 0.088 | |||
| Israel and Turkey | 22 | 3 (14%) | 19 (86%) | 1.94 (0.50–7.58) | 0.342 | |||
| Susceptibility sub-groupsf | 0.053 | |||||||
| MET-S/CLA-S (treated with PAC or PAM) | 302 | 23 (8%) | 279 (92%) | Ref | Ref | |||
| MET-S/CLA-R (treated with PAM) | 109 | 15 (14%) | 94 (86%) | 1.94 (0.97–3.86) | 0.061 | 1.90 (0.94–3.86) | 0.074 | |
| MET-R/CLA-S (treated with PAC) | 81 | 13 (16%) | 68 (84%) | 2.32 (1.12–4.81) | 0.024 | 2.69 (1.25–5.78) | 0.011 | |
| MET-R/CLA-R | 11 | 0 | 11 (100%) | N.A | N.A | |||
| Antibiotic resistance | 0.021 | |||||||
| Fully susceptibility to MET and CLA | 302 | 23 (8%) | 279 (92%) | Ref | Ref | |||
| Single resistance to MET or CLA | 190 | 28 (15%) | 162 (85%) | 2.10 (1.17–3.76) | 0.013 | 2.20 (1.22–3.98) | 0.009 | |
| Double resistance to MET and CLA | 11 | 0 | 11 (100%) | N.A | N.A | |||
| Tailored triple therapy | 0.221 | |||||||
| PPI + AMO + MET (PAM) | 218 | 18 (8%) | 200 (92%) | Ref | Ref | |||
| PPI + AMO + CLA (PAC) | 285 | 33 (12%) | 252 (88%) | 1.46 (0.80–2.66) | 0.223 | 1.59 (0.85–2.96) | 0.146 | |
| PPI dose per dayg | 0.650 | |||||||
| According to guidelines 2017 | 262 | 25 (10%) | 237 (90%) | Ref | Ref | |||
| Lower than recommended | 232 | 25 (11%) | 207 (89%) | 1.15 (0.64–2.06) | 0.650 | 1.31 (0.70–2.45) | 0.397 | |
| Amoxicillin dose per dayg | 0.500 | |||||||
| According to guidelines 2017 | 468 | 49 (10%) | 419 (90%) | Ref | Ref | |||
| Lower than recommended | 26 | 1 (4%) | 25 (96%) | 0.34 (0.05–2.58) | 0.298 | 0.32 (0.04–2.46) | 0.273 | |
| Drug intake per day | 0.220 | |||||||
| Three times per day | 97 | 6 (6%) | 91 (94%) | Ref | Ref | |||
| Two times per day | 370 | 38 (10%) | 332 (90%) | 1.74 (0.71–4.23) | 0.225 | 1.59 (0.61–4.13) | 0.339 | |
| Use of probiotics | 0.940 | |||||||
| Yes | 88 | 9 (10%) | 79 (90%) | Ref | Ref | |||
| No | 381 | 40 (11%) | 341 (89%) | 1.03 (0.48–2.20) | 0.941 | 1.19 (0.54–2.66) | 0.665 | |
| Adverse events during therapy | 0.634 | |||||||
| No | 428 | 46 (11%) | 382 (89%) | Ref | Ref | |||
| Yes | 52 | 4 (8%) | 48 (92%) | 0.69 (0.24–2.01) | 0.498 | 0.81 (0.25–2.58) | 0.716 | |
| Therapy compliance | < 0.0001 | |||||||
| ≥ 90% drug intakes | 447 | 32 (7%) | 415 (93%) | Ref | Ref | |||
| < 90% drug intakes | 30 | 11 (37%) | 19 (63%) | 7.51 (3.29–17.14) | < 0.0001 | 6.51 (2.79–15.19) | < 0.0001 |
Abbreviation: TTT tailored triple therapy, ER eradication rate, OR odd ratio, PPI proton pump inhibitor, AMO amoxicillin, CLA clarithromycin, MET metronidazole, PAC for treatment regimen with proton pump inhibitor, amoxicillin, clarithromycin, PAM for treatment regimen with proton pump inhibitor, amoxicillin, metronidazole, N.A. not applicable, ref. reference category
aP values obtained by Mann–Whitney U-test for continuous variables, while Pearson’s Chi-square test or Fisher’s exact test for categorical variables as appropriate. Bold p values indicate significant differences in the proportion of respective factors between the patient group with eradication failure and the patient group with eradication success by a p value ≤ 0.05
bCrude odd ratio (ORcrude) with 95% confidence intervals (95% CI) applied from a univariate logistic regression
cP values obtained from the Wald Chi-Square Test for the significance of the odd ratio (OR)
dAdjusted odds ratios (ORadj) with 95% confidence intervals (95% CI) obtained from the multivariable logistic regression adjusted with gender, age in years and country of living
eCountry distribution was given in supplementary file 2
fMET-S/CLA-S: Strains susceptible to both metronidazole and clarithromycin. MET-S/CLA-R: Strains susceptible to metronidazole but resistant to clarithromycin. MET-R/CLA-S: Strains resistant to metronidazole but susceptible to clarithromycin. MET-R/CLA-R: Strains resistant to both metronidazole and clarithromycin
gResults were evaluated by comparing the prescribed dose with the standard dosing regimen provided in the updated guidelines 2016 [8]