<scp> <i>Helicobacter pylori</i> </scp> Eradication Primary Care First‐Line Prescriptions: Data From 200,000 Patients in a Real‐World Cohort

ABSTRACT Background Helicobacter pylori is a common infection primarily managed in primary care. Assessing real‐world practices and guideline adherence is crucial for treatment optimisation. The study aims to assess current H. pylori management strategies using data from BIFAP, a Spanish primary care database. Materials and Methods Cohort study including patients aged ≥ 18 with recorded H. pylori infection (2003–2023) and corresponding treatment prescriptions. Infection cases were identified using ICD‐9/10 and SNOMED‐CT codes. Treatment patterns were based on Spanish and European guidelines. First‐line treatment prescriptions were compared between primary (BIFAP) and specialized (European Registry, Hp‐EuReg) care. Results A total of 211,972 H. pylori ‐ infected subjects were identified. Over the study period (20 years), the predominant first‐line treatments were: bismuth quadruple therapy including a proton‐pump inhibitor (PPI) plus a single capsule containing bismuth‐tetracycline‐metronidazole (36%); PPI + clarithromycin‐amoxicillin (30%); and PPI + clarithromycin‐amoxicillin‐metronidazole (26%). Single‐capsule bismuth quadruple therapy was the most common in patients aged 18–64 and those with obesity, chronic kidney disease, or smokers, while PPI + clarithromycin‐amoxicillin was more common in those aged ≥ 65 or with peptic ulcers. Since 2013, PPI + clarithromycin‐amoxicillin use by general practitioners and gastroenterologists decreased, though it remained above 10% in primary care at study end. PPI + clarithromycin‐amoxicillin‐metronidazole increased since 2015, with higher use in specialized care (40%) vs. primary care (30%). In 2023, single‐capsule bismuth quadruple therapy was the most prescribed regimen in both settings, accounting for ~60% of prescriptions. Conclusions Primary care H. pylori treatments are varied, with single‐capsule bismuth quadruple therapy most prescribed. Guidelines are followed, but adoption is slower in primary than in specialized care.