A prospective study of a one-week nonbismuth quadruple therapy for childhood Helicobacter pylori infection.
OBJECTIVE
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.
Chan
K L
KL
Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong Medical Center, Que'en Mary Hospital, and the Department of Paediatrics, Kwong Wah Hospital, Hong Kong, China.
Zhou
H
H
Ng
D K
DK
Tam
P K
PK
D000293:Adolescent; D000328:Adult; D000658:Amoxicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000897:Anti-Ulcer Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D017291:Clarithromycin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004378:Duodenal Diseases / Q000175:diagnosis / Q000188:drug therapy*; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage; D009853:Omeprazole / Q000008:administration & dosage; D010406:Penicillins / Q000008:administration & dosage; D011446:Prospective Studies; D013272:Stomach Diseases / Q000175:diagnosis / Q000188:drug therapy*
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D010406:Penicillins; D008795:Metronidazole; D000658:Amoxicillin; D017291:Clarithromycin; D009853:Omeprazole