New effective treatment regimen for children infected with a double-resistant Helicobacter pylori strain

Area of Science:

• Pediatric Gastroenterology
• Infectious Diseases
• Microbiology

Background:

• Increasing prevalence of multidrug-resistant Helicobacter pylori in children.
• Limited treatment options for pediatric H. pylori infections due to antibiotic licensing.
• Potential for high-dose metronidazole to overcome in vivo resistance.

Purpose of the Study:

• To evaluate the eradication rate of a high-dose triple therapy in pediatric patients with culture-proven double resistance to H. pylori.
• To assess the side effects associated with this intensified treatment regimen in children.
• To determine the safety and efficacy of amoxicillin, metronidazole, and esomeprazole for H. pylori eradication in pediatric patients.

Main Methods:

• Open multicenter trial involving 62 children (<18 years) with H. pylori resistant to metronidazole and clarithromycin.
• Treatment with high-dose amoxicillin (75 mg/kg/day), metronidazole (25 mg/kg/day), and esomeprazole (1.5 mg/kg/day) for 2 weeks.
• Eradication assessed by C-urea breath test 6 weeks post-treatment; adherence and adverse events monitored via diaries and interviews.

Main Results:

• An intention-to-treat eradication rate of 66% (41/62) and a per-protocol rate of 73% (33/45) were achieved.
• Mild to moderate adverse events reported in 21 patients, including nausea, diarrhea, and vomiting; treatment was discontinued in only one child.
• Treatment success was not correlated with the administered dose per kilogram of body weight.

Conclusions:

• High-dose amoxicillin, metronidazole, and esomeprazole for 2 weeks is a well-tolerated and effective treatment for children with H. pylori double resistance.
• This regimen represents a promising therapeutic strategy for pediatric H. pylori infections unresponsive to standard treatments.
• Further research may explore optimizing dosages and treatment durations for enhanced efficacy in pediatric populations.