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Published on: May 16, 2025
Adapted first-line treatment of Helicobacter pylori infection in Algerian children
Mostefa Moubri1,2, Nicolas Kalach3, Rezki Larras2
1Department of Paediatrics, Hospital N. Hamoud, CHU Hussein-Dey, Algiers, Algeria (Mostefa Moubri, Hassina Berrah).
Insights
A new treatment combining omeprazole, amoxicillin, and a higher dose of metronidazole (OAM10) showed higher Helicobacter pylori eradication rates in children compared to the standard regimen. This OAM10 approach is effective even with resistant strains.
Area of Science:
- Pediatric infectious diseases
- Microbiology and antibiotic resistance
- Gastroenterology
Background:
- Helicobacter pylori infection is common in children, particularly in developing nations.
- Increasing antibiotic resistance necessitates novel treatment strategies.
- This study addresses the need for effective H. pylori treatments in pediatric populations.
Purpose of the Study:
- To compare the efficacy and side effects of two H. pylori treatment regimens in children.
- To evaluate the impact of antibiotic resistance on treatment outcomes.
- To identify an optimal first-line therapy for pediatric H. pylori infections.
Main Methods:
- A prospective, randomized, blind study involving 112 symptomatic children with H. pylori infection.
- Two treatment groups: standard omeprazole-amoxicillin-clarithromycin for 7 days (OAC7) and omeprazole-amoxicillin with high-dose metronidazole for 10 days (OAM10).
- Treatments were allocated irrespective of baseline bacterial susceptibility.
Main Results:
- The OAM10 regimen achieved significantly higher eradication rates (80% ITT, 88% PP) than OAC7 (68% ITT, 71% PP).
- OAM10 was effective in treating metronidazole-resistant H. pylori strains and showed better outcomes in children over 10 years old.
- Adverse effects were mild to moderate, primarily gastrointestinal, and well-tolerated in both groups.
Conclusions:
- The OAM10 regimen demonstrates superior therapeutic efficacy compared to the standard OAC7 treatment.
- The OAM10 regimen is well-tolerated and cost-effective.
- OAM10 is recommended as a suitable first-line treatment for pediatric H. pylori infections, especially in regions with high resistance rates.
Background:
Helicobacter pylori (H. pylori) infection is acquired in early life and continues to have a high prevalence, especially in developing countries. Growing antibiotic-resistant strains necessitate adapted treatments. This study aimed to compare the efficacy, side effects, and influence of resistance of H. pylori strains between two different treatments.
Methods:
This prospective, randomized blind study enrolled 112 symptomatic children infected with H. pylori (66 girls, mean age 11.1 years). Treatments, allocated randomly irrespective of the susceptibility of the strains, were either the standard omeprazole-amoxicillin-clarithromycin combination for 7 days (OAC7; group A) or omeprazole-amoxicillin with a higher dose of metronidazole (40 instead of 20 mg/kg/d) for 10 days (OAM10; group B).
Results:
Before treatment, the resistance rates of H. pylori strains to metronidazole or clarithromycin were 37% and 13%, respectively, with 7% resistant to both antibiotics and neither to amoxicillin. Eradication rates obtained with OAM10 (80% by intention-to-treat [ITT] and 88% by per protocol [PP] analysis) were higher than with OAC7 (68% in ITT and 71% PP) and the differences (12% in ITT and 17% PP) were statistically significant (P=0.03). Successful treatments with OAM10 were obtained in metronidazole resistant strains and were more effective in children aged >10 years (P=0.02 by ITT and P=0.04 by PP). Only light or moderate side effects, mainly digestive, were observed.
Conclusion:
Because of its therapeutic efficacy, good tolerance and lower cost the OAM10 can be considered as an appropriate first-line therapeutic scheme in Algeria.
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