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Author Spotlight: Detection and Treatment of Helicobacter pylori Infection
Published on: July 28, 2023
Treatment of Pediatric Helicobacter pylori Infection
Hung-Hsiang Lai1,2, Ming-Wei Lai2,3
1Department of Pediatrics, New Taipei Municipal Tu Cheng Hospital, Chang Gung Memorial Hospital, New Taipei City 23656, Taiwan.
Insights
Treating pediatric Helicobacter pylori infection is challenging, with current therapies often failing to reach the desired >90% eradication rate due to antibiotic resistance and compliance issues.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Helicobacter pylori infection is a significant cause of gastrointestinal diseases in children, including gastritis, ulcers, and potentially gastric cancer.
- Effective treatment is crucial but complicated by regional antibiotic resistance patterns and the lack of routine susceptibility testing.
- Current treatment strategies often rely on empirical approaches based on clinical experience and regional data.
Purpose of the Study:
- To systematically review and integrate current treatment strategies for pediatric Helicobacter pylori infection.
- To evaluate the efficacy of various first-line therapies in achieving recommended eradication rates in children.
- To identify challenges and areas for improvement in the management of pediatric H. pylori infections.
Main Methods:
- A systematic literature review was conducted using major databases (PubMed, Cochrane Library, EMBASE, Scholar).
- Searches included terms related to Helicobacter pylori and pediatric populations, covering publications from January 2011 to December 2021.
- Relevant manuscripts and clinical guidelines were analyzed for treatment efficacy and outcomes.
Main Results:
- First-line therapies, including triple, sequential, concomitant, and bismuth-based quadruple therapies, often failed to achieve the target eradication rate of >90% in pediatric H. pylori infections.
- Adjuvant therapy with probiotics also did not consistently meet the desired efficacy benchmarks.
- Eradication rates were suboptimal, likely influenced by regional variations in antibiotic resistance and potential issues with pediatric patient compliance.
Conclusions:
- Current standard therapies demonstrate unsatisfactory eradication rates for pediatric H. pylori infections.
- Antibiotic resistance and challenges with treatment adherence in children are significant barriers to successful eradication.
- Further research is essential to develop evidence-based, optimized treatment protocols for pediatric H. pylori management.
Abstract:
Helicobacter pylori infection can cause gastritis, gastric or duodenal ulcers, mucosa-associated lymphoid tissue lymphoma, gastric cancer, and extra-gastrointestinal manifestations. Ideal treatment should be guided by antibiotic susceptibility testing. However, this is not feasible in many regions, so the treatment generally relies on clinical experience and regional culture sensitivity profiles. We aimed to integrate the treatment of pediatric H. pylori infection through a systematic literature review. Databases including PubMed, Cochrane Library, EMBASE, and Scholar were searched using terms containing (Helicobacter OR Helicobacter pylori OR H. pylori) AND (child OR pediatric) for all relevant manuscripts and guidelines, published from January 2011 to December 2021. The eradication rate for pediatric H. pylori infection was not satisfactory using triple therapy, sequential therapy, concomitant therapy, bismuth-based quadruple therapy, or adjuvant therapy with probiotics as the first-line therapy. Most therapies could not achieve the recommended eradication rate of >90%, which may be attributed to varying regional antibiotic resistance and possible poor children’s compliance. More studies are required to establish a best practice for pediatric H. pylori infection treatment.
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