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

J Pediatr Surg. 2001 Jul;36(7):1008-11. doi: 10.1053/jpsu.2001.24726.

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 nonbismuth 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-we'ek 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 H pylori 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.

MeSH terms

  • Adolescent
  • Adult
  • Amoxicillin / administration & dosage
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Ulcer Agents / administration & dosage
  • Child
  • Child, Preschool
  • Clarithromycin / administration & dosage
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Duodenal Diseases / diagnosis
  • Duodenal Diseases / drug therapy*
  • Helicobacter Infections / diagnosis
  • Helicobacter Infections / drug therapy*
  • Helicobacter pylori*
  • Humans
  • Metronidazole / administration & dosage
  • Omeprazole / administration & dosage
  • Penicillins / administration & dosage
  • Prospective Studies
  • Stomach Diseases / diagnosis
  • Stomach Diseases / drug therapy*

Substances

  • Anti-Bacterial Agents
  • Anti-Ulcer Agents
  • Penicillins
  • Metronidazole
  • Amoxicillin
  • Clarithromycin
  • Omeprazole