Helicobacter pylori eradication in the Swedish population.
OBJECTIVE
Helicobacter pylori is associated with peptic ulcers and gastric cancer and its eradication aims to prevent these conditions. The recommended eradication regimen is triple therapy, consisting of a proton-pump inhibitor in combination with clarithromycin and amoxicillin or metronidazole for 7 days. Yet, other antibiotic regimens are sometimes prescribed. We aimed to assess the use of eradication therapy for H. pylori in the Swedish population during the last decade.


METHODS
This population-based study used data from the Swedish Prescribed Drug Register. From July 2005 until December 2014, all regimens that can eradicate H. pylori were identified and evaluated according to patients' age and sex and calendar year of eradication.


RESULTS
We identified 157,915 eradication episodes in 140,391 individuals (53.8% women, 42.6% older than 60 years), who correspond to 1.5% of the Swedish population. The absolute number and incidence of eradications decreased over the study period. Overall, 91.0% had one eradication and 0.1% had more than three. Of all eradications, 95.4% followed the recommended regimen, while 4.7% did not. The latter group was overrepresented among individuals aged ≥80 years (7.8%). Amoxicillin and clarithromycin were most frequently prescribed, while metronidazole was rarely used (0.01%). Other prescribed antibiotics were ciprofloxacin (2.4%), doxycycline (1.4%), nitrofurantoin (0.7%), norfloxacin (0.5%) and erythromycin (0.3%).


CONCLUSIONS
During the last decade in Sweden H. pylori eradication has been frequently prescribed, but the incidence of eradication has slowly declined. Most eradications followed the recommended regimen, including those occurring after a previous eradication.
a Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden.
Eva
E
Doorakkers
a Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden.|b Division of Cancer Studies , King's College London , London , UK.
Jesper
J
Lagergren
a Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden.
Vijaya Krishna
VK
Gajulapuri
c Department of Internal Medicine and Infectious Diseases , Ghent University , Ghent , Belgium.
Steven
S
Callens
d Centre for Translational Microbiome Research, Department of Microbiology, Tumor and Cell Biology , Karolinska Institutet , Stockholm , Sweden.|e Science for Life Laboratory , Stockholm , Sweden.
Lars
L
Engstrand
a Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden.|d Centre for Translational Microbiome Research, Department of Microbiology, Tumor and Cell Biology , Karolinska Institutet , Stockholm , Sweden.|e Science for Life Laboratory , Stockholm , Sweden.
Nele
N
Brusselaers
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000145:classification / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D017291:Clarithromycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000453:epidemiology*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D017678:Sex Distribution; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D000658:Amoxicillin; D017291:Clarithromycin
Helicobacter pylori; Sweden; antibiotics; epidemiology; eradication; population-based