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Results of triple eradication therapy in Japanese children: a retrospective multicenter study
Seiichi Kato1, Mutsuko Konno, Shun-Ichi Maisawa
1Department of Pediatrics, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, 980-8574 Sendai, Japan.
Insights
Proton pump inhibitor (PPI)-based triple therapies, particularly the PAC regimen, are effective for Helicobacter pylori eradication in children. Clarithromycin resistance impacts treatment success, making metronidazole a suitable second-line option.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Limited large-scale clinical trials exist for Helicobacter pylori eradication therapies in pediatric populations.
- Proton pump inhibitor (PPI)-based triple therapies are common but require efficacy assessment in children.
Purpose of the Study:
- To evaluate the efficacy of first- and second-line proton pump inhibitor (PPI)-based triple therapies for Helicobacter pylori eradication in Japanese children.
- To assess the impact of antibiotic resistance on treatment outcomes.
Main Methods:
- Retrospective analysis of pediatric gastrointestinal unit data (1996-2003).
- Collected data on drug regimens, compliance, eradication success, ulcer healing, and symptom response.
- Antibiotic susceptibility testing was performed where applicable.
Main Results:
- First-line PPI plus amoxicillin and clarithromycin (PAC) achieved 77.4% eradication; PPI plus amoxicillin and metronidazole (PAM) achieved 87.5%.
- Second-line PAM therapy in patients with failed PAC achieved 100% eradication.
- Clarithromycin resistance (34.7%) was associated with significantly lower PAC efficacy (40.0% vs. 91.7% for susceptible strains).
- H. pylori eradication correlated with ulcer healing and symptom improvement in gastritis patients.
- Eradication led to increased hemoglobin levels in anemic children.
Conclusions:
- The PAC regimen demonstrates effectiveness in pediatric H. pylori eradication.
- Clarithromycin resistance is a significant factor in treatment failure.
- Metronidazole serves as an effective second-line alternative to clarithromycin.
Background:
Large-scale clinical trials in children are lacking concerning Helicobacter pylori eradication therapies. The purpose of this study was to assess the efficacy of proton pump inhibitor (PPI)-based triple therapies in Japanese children.
Methods:
This was a retrospective analysis of the first- and second-line PPI-based triple therapies from pediatric gastrointestinal units between 1996 and 2003. Data collected included doses and duration of regimens, drug compliance, success or failure of eradication, ulcer healing, and symptom response of those with dyspepsia and no ulcers. The results of antibiotic susceptibility tests were also reported in cases where these were performed.
Results:
A total of 149 pediatric patients (mean age, 12.6 years) were studied, including 123 patients who received first-line therapy: 115 received a PPI plus amoxicillin and clarithromycin (PAC) and 8 received a PPI plus amoxicillin and metronidazole (PAM). Overall eradication rates of the first-line PAC and PAM therapies were 77.4% and 87.5%, respectively ( P = 0.68). All 14 patients with failed PAC therapy received the second-line PAM regimen, resulting in an eradication rate of 100%. Mild side effects were reported only in PAC regimens (13.8%). Primary resistance to amoxicillin, clarithromycin, and metronidazole was detected in 0%, 34.7%, and 12.5% of the strains, respectively. The PAC regimen showed a high eradication rate for clarithromycin-susceptible strains (91.7%), but was relatively ineffective for resistant strains (40.0%) ( P < 0.01). Eradication of H. pylori was associated with ulcer healing and symptomatic improvement among those with gastritis only (both; P < 0.001). Among 17 patients with iron-deficiency anemia, post-treatment hemoglobin levels were higher than the pretreatment levels ( P < 0.001).
Conclusions:
The PAC regimen is effective in children. Clarithromycin resistance is associated with eradication failure. Metronidazole is a good substitute for clarithromycin as the second-line option for children.
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