A prospective study of a one-week nonbismuth quadruple therapy for childhood Helicobacter pylori infection
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1Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong Medical Center, Que'en Mary Hospital, and the Department of Paediatrics, Kwong Wah Hospital, Hong Kong, China.
Insights
A 1-week quadruple therapy effectively eradicates Helicobacter pylori in children, even with high metronidazole resistance. This treatment also heals ulcers and erosions, improving pediatric gastrointestinal health.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Helicobacter pylori infection is a common cause of pediatric gastrointestinal conditions.
- Standard eradication therapies face challenges due to increasing antibiotic resistance, particularly to metronidazole.
- Short-duration therapies enhance patient compliance but require careful evaluation of efficacy.
Purpose of the Study:
- To assess the effectiveness of a 1-week nonbismuth quadruple therapy for Helicobacter pylori eradication in children.
- To evaluate treatment outcomes in a population with a high prevalence of metronidazole-resistant H. pylori strains.
- To correlate eradication success with symptom resolution and endoscopic findings.
Main Methods:
- Prospective study of pediatric patients with upper gastrointestinal conditions requiring endoscopy.
- H. pylori diagnosis via rapid urease test and histopathology on gastric biopsies.
- Treatment with omeprazole, clarithromycin, amoxicillin, and metronidazole for 7 days, with re-treatment if necessary.
- Assessment of eradication success via endoscopy and biopsy 1 month post-treatment.
Main Results:
- A 94% eradication rate was achieved with the 1-week quadruple therapy in 33 children.
- All treated peptic ulcers and erosions healed following H. pylori eradication.
- One patient with dual clarithromycin and metronidazole resistance did not respond to initial treatment.
Conclusions:
- The 1-week quadruple therapy (omeprazole, clarithromycin, amoxicillin, metronidazole) is effective for H. pylori eradication in children, even with high metronidazole resistance.
- Successful eradication leads to the healing of peptic ulcers and erosions.
- While effective, persistent symptoms in a small subset warrant further investigation.
Purpose:
In the eradication of Helicobacter pylori infection, a 1-week therapy improves patient compliance, but drug resistance may limit its efficacy. The effectiveness of the 1-week nonbismuth quadruple therapy was studied prospectively in children with proven H pylori infection in a population with a high rate of metronidazole resistance.
Methods:
All pediatric patients who presented to our institutions with acute and chronic upper gastrointestinal conditions requiring endoscopy from June 1997 to February 2000 were investigated prospectively for H pylori infection. Gastric biopsy specimens were analyzed with rapid urease test and histopathology, H pylori-positive children were treated with omeprazole, clarithromycin, amoxicillin, and metronidazole for 7 days. The result of treatment was assessed 1 month after treatment with endoscopy and biopsy. The same treatment was repeated for 2 weeks if H pylori was still present. In patients who needed a third endoscopy, their biopsy specimens were cultured to determine antibiotic sensitivity. Results were correlated with patients' symptoms and endoscopic findings.
Results:
Thirty-three children with acute (severe epigastric pain, n = 14; gastrointestinal bleeding, n = 9) and chronic (recurrent abdominal pain, n = 7; anemia, n = 3) conditions were treated for H pylori. Thirty-one (94%) were confirmed to have H pylori eradicated by a 1-week therapy, whereas 1 patient had eradication after a further 2-we'ek therapy (3.3%). The only unresponsive patient had H pylori resistant to both clarithromycin and metronidazole. All ulcers and erosions healed after the eradication of H pylori. Three patients had persistent recurrent abdominal pain despite H pylori eradication.
Conclusions:
The 1-week therapy with omeprazole, clarithromycin, amoxicillin, and metronidazole is an effective treatment of H pylori in children in a population with a high incidence of metronidazole resistant strain of H pylori. Peptic ulcers and erosions healed with the eradication of the bacteria.
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