A prospective study of a one-week non- bismuth quadruple therapy for childhood Helicobacter pylori infection

Abstract

Purpose: In The Eradication Of Helicobacter Pylori Infection, A 1-Week Therapy Improves Patient Compliance, But Drug Resistance May Limit Its Efficacy. The Effectiveness Of The 1-Week Nonbismouth Quadruple Therapy Was Studied Prospectively In Children With Proven H Pylori Infection In A Population With A High Rate Of Metronidazole Resistance. Methods:All Pediatric Patients Who Presented To Our Institutions With Acute And Chronic Upper Gastrointestinal Conditions Requiring Endoscopy From June 1997 To February 2000 Were Investigated Prospectively For H Pylori Infection. Gastric Biopsy Specimens Were Analyzed With Rapid Urease Test And Histopathology, H Pylori-Positive Children Were Treated With Omeprazole, Clarithromycin, Amoxicillin, And Metronidazole For 7 Days. The Result Of Treatment Was Assessed 1 Month After Treatment With Endoscopy And Biopsy. The Same Treatment Was Repeated For 2 Weeks If H Pylori Was Still Present. In Patients Who Needed A Third Endoscopy, Their Biopsy Specimens Were Cultured To Determine Antibiotic Sensitivity. Results Were Correlated With Patients' Symptoms And Endoscopic Findings. Results: Thirty-Three Children With Acute (Severe Epigastric Pain, N = 14; Gastrointestinal Bleeding, N = 9) And Chronic (Recurrent Abdominal Pain, N = 7; Anemia, N = 3) Conditions Were Treated For H Pylori. Thirty-One (94%) Were Confirmed To Have H Pylori Eradicated By A 1-Week Therapy, Whereas 1 Patient Had Eradication After A Further 2-Week Therapy (3.3%). The Only Unresponsive Patient Had H Pylori Resistant To Both Clarithromycin And Metronidazole. All Ulcers And Erosions Healed After The Eradication Of H Pylori. Three Patients Had Persistent Recurrent Abdominal Pain Despite H Pylori Eradication. Conclusions: The 1-Week Therapy With Omeprazole, Clarithromycin, Amoxicillin, And Metronidazole Is An Effective Treatment Of Hpylori In Children In A Population With A High Incidence Of Metronidazole Resistant Strain Of H Pylori. Peptic Ulcers And Erosions Healed With The Eradication Of The Bacteria. Copyright © 2001 W.B. Saunders Company.