TREATMENT REGIMEN PATTERNS, ADHERENCE AND ERADICATION FAILURE IN COMMUNITY PHARMACY–DISPENSED HELICOBACTER PYLORI THERAPY IN BAYELSA STATE, NIGERIA: A CROSS-SECTIONAL ANALYSIS WITH IMPLICATIONS FOR ANTIMICROBIAL STEWARDSHIP

Timi Fiekumo Buseri, Chukwuemeka Chibuzo Gloria, Owonaro A Peter*, Ibegi, Ibegi Saviour, Olodiama, Providencia Chichi, Henry Messiah TMT

ABSTRACT

Background: Helicobacter pylori eradication is a cornerstone of peptic ulcer disease (PUD) management and a key preventive strategy against gastric malignancy, yet eradication success depends on guideline-concordant regimen selection, treatment adherence, and post-treatment verification of cure — all of which are vulnerable in community pharmacy settings in low- and middle-income countries. This study evaluated treatment regimens dispensed, adherence patterns, eradication outcomes, and antimicrobial stewardship implications of community pharmacy–dispensed H. pylori therapy in Bayelsa State, Nigeria. Methods: A descriptive, analytical, cross-sectional study was conducted among adults with PUD attending community pharmacies in Yenagoa metropolis. A structured interviewer-assisted questionnaire was administered to 428 participants; 412 (96.3%) returned complete responses, and 183 met the case definition for PUD. Data were analysed in IBM SPSS Statistics version 26.0 using descriptive statistics, chi-square tests, and an independent-samples t-test. Statistical significance was set at α = 0.05. Results: Sequential therapy was the most frequently dispensed regimen (45.4%), followed by triple therapy and proton pump inhibitor (PPI)–based combinations. Only 35.0% of respondents completed the prescribed course as directed; 39.3% discontinued prematurely due to adverse effects, and 15.3% had not commenced treatment at the time of survey. Regimen completion was statistically associated with treatment outcome (p = 0.043). Eradication failure — defined as persistent H. pylori positivity post-treatment — was reported in 39.9% of treated respondents (p = 0.028). Critically, 25.7% of respondents had no post-treatment confirmatory testing performed. Patient-reported adverse effects were dominated by taste disturbance (48 cases), diarrhoea (41 cases), and nausea (41 cases). An independent-samples t-test confirmed a statistically significant association between management strategy score and clinical outcome (t(183) = 1.800, p = 0.025), with improved outcomes associated with a higher mean management strategy score (M = 2.21, SD = 1.155) compared to worsened outcomes (M = 1.00). Conclusion: Community pharmacy–dispensed H. pylori therapy in Bayelsa State is characterized by substantial regimen-completion deficits, an alarming eradication failure rate of approximately 40%, and widespread absence of test-of-cure — a constellation of practice patterns with direct implications for antimicrobial resistance amplification. Urgent investment is required in structured patient counselling, standardised test-and-treat protocols aligned with the Maastricht VI/Florence consensus, mandatory post-treatment confirmatory testing, and embedded antimicrobial stewardship oversight of community pharmacy H. pylori practice.

Keywords:

Helicobacter pylori; eradication therapy; treatment adherence; antimicrobial resistance; antimicrobial stewardship; community pharmacy; Nigeria; Bayelsa State

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