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Sequential therapy compared with standard triple therapy for Helicobacter pylori eradication in children: a
Piotr Albrecht1, Maria Kotowska, Hania Szajewska
1Department of Pediatric Gastroenterology and Nutrition, The Medical University of Warsaw, Warsaw, Poland.
Insights
Sequential therapy demonstrated a higher Helicobacter pylori eradication rate in children compared to standard triple therapy. This approach offers a promising alternative for pediatric H. pylori treatment.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Helicobacter pylori infection is common in children.
- Standard triple therapy has variable eradication rates.
- Novel treatment strategies are needed for pediatric H. pylori infections.
Purpose of the Study:
- To compare the effectiveness of sequential therapy versus standard triple therapy for H. pylori eradication in children.
- To evaluate eradication rates and safety profiles of two different H. pylori treatment regimens in a pediatric population.
Main Methods:
- A double-blind, randomized, controlled trial was conducted in 107 children with confirmed H. pylori infection.
- Sequential therapy involved amoxicillin and omeprazole followed by clarithromycin, tinidazole, and omeprazole.
- Standard triple therapy consisted of amoxicillin, clarithromycin, and omeprazole for 7 days.
Main Results:
- The sequential therapy group achieved a significantly higher H. pylori eradication rate (86.5%) compared to the standard triple therapy group (68.6%).
- The difference in eradication rates was statistically significant (relative risk, 1.26; 95% CI, 1.02-1.60).
- No significant differences were observed in adverse effects, treatment discontinuation, or compliance between the groups.
Conclusions:
- Sequential eradication therapy is more effective than standard triple therapy for H. pylori eradication in children.
- The higher eradication rate achieved with sequential therapy warrants its consideration in pediatric H. pylori treatment protocols.
- While statistically borderline, the improved efficacy suggests sequential therapy as a valuable alternative.
Objective:
To determine the effectiveness of sequential therapy compared with standard triple therapy for Helicobacter pylori eradication in children.
Study Design:
In 107 children with H pylori infection confirmed with 2 of 3 tests ((13)C-urea breath test, histopathology, rapid urease test), we conducted a double-blind, randomized, controlled trial comparing a sequential treatment (amoxicillin and omeprazole for 5 days followed by clarithromycin, tinidazole, and omeprazole for 5 days) to a 7-day standard triple eradication regimen (amoxicillin and clarithromycin plus omeprazole) followed by placebo for 3 days.
Results:
In the experimental group (n=52) compared with the control group (n=51), there was a significant difference in the H pylori eradication rate at 6 to 8 weeks after the completion of treatment (primary outcome), as confirmed with negative results on (13)C-urea breath test (45/52 or 86.5% versus 35/51 or 68.6%; relative risk, 1.26; 95% CI, 1.02-1.60). Groups did not differ in any of the secondary outcomes (ie, adverse effects, the need for discontinuation of the H pylori therapy, compliance with therapy).
Conclusions:
In children with H pylori infection, sequential eradication therapy compared with standard triple therapy resulted in a higher eradication rate, although the difference was of borderline statistical significance.
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