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Sequential therapy versus tailored triple therapies for Helicobacter pylori infection in children
Patrick Bontems1, Nicolas Kalach, Giuseppina Oderda
1Pediatric Gastroenterology-Hepatology, Queen Fabiola Children's University Hospital, Brussels, Belgium. patrick.bontems@huderf.be
Insights
Sequential treatment effectively eradicates Helicobacter pylori (H pylori) in children, but its success depends on clarithromycin (CLA) susceptibility. Tailored triple therapy is less effective against CLA-resistant strains.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Antimicrobial Therapy
Background:
- Helicobacter pylori (H pylori) infection is a significant cause of pediatric gastrointestinal issues.
- Optimizing eradication strategies in children is crucial due to increasing antimicrobial resistance.
- Previous studies have shown varying efficacy of different H pylori treatment regimens in pediatric populations.
Purpose of the Study:
- To compare the efficacy of sequential versus tailored triple therapy for H pylori eradication in children.
- To evaluate the impact of antimicrobial susceptibility, particularly to clarithromycin (CLA), on treatment outcomes.
- To assess the safety and tolerability of both treatment regimens.
Main Methods:
- A prospective, open-label, multicenter study involving 165 children.
- Randomized assignment to either a 10-day sequential therapy (omeprazole, amoxicillin, clarithromycin, metronidazole) or a 7-day tailored triple therapy.
- Treatment selection for triple therapy was based on CLA susceptibility testing.
Main Results:
- Overall intention-to-treat (ITT) eradication rates were 81.9% for sequential therapy and 71.9% for triple therapy (not significant).
- Per-protocol (PP) eradication rates were 88.3% for sequential and 81.8% for triple therapy (not significant).
- Sequential therapy showed significantly higher eradication rates in children with susceptible strains (ITT: 87.8% vs. 68.5%) and significantly lower rates in those with CLA-resistant strains (ITT: 56.2% vs. 72.7%).
Conclusions:
- Sequential treatment is highly effective for H pylori eradication in children, particularly when strains are susceptible to clarithromycin and metronidazole.
- Efficacy of sequential therapy is compromised in cases of clarithromycin resistance.
- Sequential therapy can be considered a first-line option for H pylori eradication in children, provided CLA resistance rates are low in the specific geographic area.
Aims:
The aim of the study was to compare sequential versus tailored triple therapy regimens on Helicobacter pylori (H pylori) eradication rates in children and to assess the effect of antimicrobial susceptibility.
Patients And Methods:
Prospective, open-label, multicenter study. Children received randomly either a 10-day sequential treatment comprising omeprazole (OME) with amoxicillin for 5 days and OME, clarithromycin (CLA), and metronidazole (MET) for the remaining 5 days, or a 7-day triple therapy comprising OME with amoxicillin and CLA in cases of a CLA-susceptible strain or MET in cases of CLA-resistant strain. H pylori eradication was assessed by C-urea breath test.
Results:
One hundred sixty-five children, 95 girls and 70 boys, of median age 10.4 years, were included. The intention-to-treat (ITT) eradication rate was 76.9% (sequential 68/83 = 81.9%, triple therapy 59/82 = 71.9%, ns), and the per-protocol (PP) eradication rate was 84.6% (sequential 68/77 = 88.3%, triple therapy 59/73 = 81.8%, ns). Eradication rates tended to be higher using the sequential treatment, but the difference was only statistically significant for ITT analysis in children harboring both CLA- and MET-susceptible strains (87.8% vs 68.5%, odds ratio [OR] 3.3, P = 0.03). Both ITT and PP eradication rates were significantly lower with sequential treatment in CLA-resistant compared with CLA-susceptible strains (ITT: 56.2% vs 72.7%, OR 5.5, P = 0.008; PP 64.3% vs 80.0%, OR 7.9, P = 0.009). Both treatments were well tolerated.
Conclusions:
Sequential treatment is greatly effective for eradicating H pylori in children except in CLA-resistant strains. Sequential treatment can be used as a first-line therapy, but only in areas with a low CLA resistance rate.
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