Aims
Helicobacter Pylori (HP) is a class-1 carcinogen and Bismuth Quadruple Therapy (BQT) has recently been recommended as first line eradication therapy in Ireland. Previous local audits have shown that there is a variety of prescribed therapy for HP eradication; causes include unfamiliarity with BQT and cumbersome prescription. When BQT was used, eradication rates in our local service was 90%.
Since January 2025, we introduced a simple pro-forma prescription in Cavan Monaghan Hospital for BQT that only requires prescribers’ identifiers. The aim of this audit was to assess prescribing rates of BQT since introduction.Since January 2025, we introduced a simple pro-forma prescription in Cavan Monaghan Hospital for BQT that only requires prescribers’ identifiers. The aim of this audit was to assess prescribing rates of BQT since introduction.
Methods
We reviewed both physical and electronic records of patients who had a positive Rapid Urease Test (RUT) over a 1 year period (July 2024-July 2025). We then compared prescribing practices of HP eradication once the pro-forma was introduced. We also checked return rates of HP stool antigen post eradication therapy, which is the only non-invasive HP test available to us.
Results
Over the 1 year period, we had a total of 202 positive RUT tests. Incomplete data sets were removed and only 201 cases was included in the analysis. 108 (54%) had positive RUT prior to proforma introduction and 93 (46%) after.
In total prior to introduction of pro forma – 69 (64%) patients were prescribed Triple Therapy (TT); 39 (36%) was given BQT.
After the pro forma introduction TT was prescribed in only 10 (11%) patients and BQT was prescribed in 83 (89%) patients.
Overall stool return rate for HP serology was only 53% (106 patient), eradication was achieved in 92% (98).
Conclusions
The introduction of the pro-forma BQT prescription has shown that there has been a marked increase (53% increase) in the use of the most effective nationally recommended HP eradication regimen. In line with previous studies, stool sample returns were low; limiting data on post treatment eradication. This supports the development of other services including Urea Breath Testing for diagnosis and to assess post treatment eradication.