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Published on: November 17, 2018
Long-term changes in the gut microbiota after 14-day bismuth quadruple therapy in penicillin-allergic children
Ying Zhou1, Ziqing Ye1, Junping Lu1
1Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China.
Insights
Bismuth quadruple therapy temporarily alters gut microbiota in penicillin-allergic children with Helicobacter pylori infection. Most gut bacteria return to normal levels one year after treatment, showing long-term safety.
Area of Science:
- Microbiology
- Pediatric Gastroenterology
- Pharmacology
Background:
- Penicillin-allergic children with Helicobacter pylori (H. pylori) infections are a common subgroup requiring treatment.
- Bismuth quadruple therapy is a common treatment regimen for H. pylori infections.
Purpose of the Study:
- To investigate the short-term and long-term effects of bismuth quadruple therapy on the gut microbiota of penicillin-allergic children.
- To assess the safety and recovery of gut microbiota after H. pylori eradication therapy.
Main Methods:
- Prospective study of treatment-naive children with H. pylori infection and H. pylori-negative controls.
- 14-day bismuth quadruple therapy (omeprazole, clarithromycin, metronidazole, bismuth).
- 16S rRNA gene sequencing of fecal samples collected at baseline, 2 weeks, 6 weeks, and 52 weeks post-treatment.
Main Results:
- Bismuth quadruple therapy significantly reduced gut microbial alpha and beta diversity at 2 weeks post-treatment.
- Relative abundance of Bacteroidetes decreased, while Proteobacteria increased; beneficial bacteria like Bacteroides and Faecalibacterium decreased, and detrimental bacteria like Enterococcus increased.
- Gut microbiota alterations were largely restored to baseline levels by 52 weeks post-treatment, indicating recovery.
Conclusions:
- Bismuth quadruple therapy induces short-term gut microbiota dysbiosis in penicillin-allergic children.
- The gut microbiota largely recovers one year after H. pylori eradication therapy.
- This suggests the long-term safety of bismuth quadruple therapy in this pediatric population.
Background:
Penicillin-allergic children who are infected with Helicobacter pylori constitute a relatively common subgroup. We aimed to study the short-term and long-term effects of bismuth quadruple therapy on gut microbiota in penicillin-allergic children.
Methods:
We prospectively recruited treatment-naive children with H pylori infection and H pylori-negative asymptomatic children as healthy controls. Patients received 14-day bismuth quadruple therapy consisting of omeprazole, clarithromycin, metronidazole, and bismuth. Fecal samples were collected at weeks 0, 2, 6, and 52. Alterations in the gut microbiota were analyzed by 16S rRNA gene sequencing.
Results:
Twenty-two subjects (14 gastritis patients, 8 duodenal ulcer patients) and 23 controls participated in this study. At week 2, alpha diversity was reduced in both gastritis (P < .05) and ulcer (except P = .16 with Chao 1 index) patients compared with baseline. Some changes persisted at week 6, and all were restored at week 52. Beta diversity was significantly altered 2 weeks after treatment in the gastritis and duodenal ulcer groups (P = .001, P = .002, respectively) and restored at weeks 6 and 52. The mean relative abundance of Bacteroidetes (P < .001, P = .005, respectively) decreased and that of Proteobacteria increased (P < .001, P = .03, respectively). All alterations recovered at week 6 and 52. In both the gastritis and ulcer groups at week 2, some beneficial bacteria were decreased including Bacteroides (P < .001 and P = .003), Faecalibacterium (P < .001 and P = .02), Phascolarctobacterium (P = .002 and P = .004), Roseburia ( P < .001 and P = .13), Bifidobacterium (P = .08 and P = .04), and Blautia (P < .001 and P = .002). Some detrimental bacteria were increased including Escherichia-Shigella (P < .001 and P = .19), Klebsiella (P < .001, and P = .09), Enterococcus (P < .001 and P = .007), and Streptococcus (P = .002 and P = .004). The changes returned to almost the pre-eradication level 1 year after therapy.
Conclusion:
Bismuth quadruple therapy causes short-term dysbiosis of the gut microbiota. Most changes recovered 1-year post-eradication, indicating the long-term safety of H pylori therapy.
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