[Treatment of Helicobacter pylori in children]

There are very few studies that compare therapeutic protocols against H. pylori infection in children and the few available data derive from studies that usually evaluate the remission of symptoms or the accuracy of diagnostic procedures before and after treatment. Furthermore, no randomised, controlled clinical trials using placebo have been carried out in children.

We systematically collected data from the pediatric literature on the treatment of H. pylori to assess the efficacy of various treatments. This review included all articles and letters published since 1987 and all abstracts presented at the three main international meetings from 1997 to 1999. The results of studies published in English and French journals were collected and analysed.

We only found 30 articles and 17 abstracts containing results on the treatment of H. pylori, carried out respectively in a total of 870 and 1552 children. All the data collected seemed to indicate that single-therapy or dual therapy with an antisecretory drug combined with an antibiotic showed a low level of efficacy. Dual therapy proved effective, in the form of bismuth and one antibiotic (amoxycillin or a nitroimidazole) or two antibiotics when administered for two or more weeks. The same was true of triple therapy based on bismuth or a proton pump inhibitor associated with two antibiotics. Triple therapies were less effective in children than in adults, and although triple therapies based on bismuth were more effective when administered for at least two weeks, the triple therapies based on a proton pump inhibitor showed a comparable level of efficacy irrespective of duration.

Dual therapies in children using two antibiotics appear to have a similar efficacy as triple therapies, and if the latter contain a proton pump inhibitor, they show a similar efficacy irrespective of duration. For this reason, it does not seem necessary to administer them for more than one week.