title: Results of triple eradication therapy in Japanese children: a retrospective multicenter study.
abstract: BACKGROUND
  Large-scale clinical trials in children are lacking concerning Helicobacter pylori eradication therapies. The purpose of this study was to assess the efficacy of proton pump inhibitor (PPI)-based triple therapies in Japanese children.
  
  
  METHODS
  This was a retrospective analysis of the first- and second-line PPI-based triple therapies from pediatric gastrointestinal units between 1996 and 2003. Data collected included doses and duration of regimens, drug compliance, success or failure of eradication, ulcer healing, and symptom response of those with dyspepsia and no ulcers. The results of antibiotic susceptibility tests were also reported in cases where these were performed.
  
  
  RESULTS
  A total of 149 pediatric patients (mean age, 12.6 years) were studied, including 123 patients who received first-line therapy: 115 received a PPI plus amoxicillin and clarithromycin (PAC) and 8 received a PPI plus amoxicillin and metronidazole (PAM). Overall eradication rates of the first-line PAC and PAM therapies were 77.4% and 87.5%, respectively ( P = 0.68). All 14 patients with failed PAC therapy received the second-line PAM regimen, resulting in an eradication rate of 100%. Mild side effects were reported only in PAC regimens (13.8%). Primary resistance to amoxicillin, clarithromycin, and metronidazole was detected in 0%, 34.7%, and 12.5% of the strains, respectively. The PAC regimen showed a high eradication rate for clarithromycin-susceptible strains (91.7%), but was relatively ineffective for resistant strains (40.0%) ( P < 0.01). Eradication of H. pylori was associated with ulcer healing and symptomatic improvement among those with gastritis only (both; P < 0.001). Among 17 patients with iron-deficiency anemia, post-treatment hemoglobin levels were higher than the pretreatment levels ( P < 0.001).
  
  
  CONCLUSIONS
  The PAC regimen is effective in children. Clarithromycin resistance is associated with eradication failure. Metronidazole is a good substitute for clarithromycin as the second-line option for children.
authors.affiliation: Department of Pediatrics, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, 980-8574 Sendai, Japan.
authors.forename: Seiichi
authors.initials: S
authors.lastname: Kato
authors.forename: Mutsuko
authors.initials: M
authors.lastname: Konno
authors.forename: Shun-Ichi
authors.initials: S
authors.lastname: Maisawa
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Tajiri
authors.forename: Norikazu
authors.initials: N
authors.lastname: Yoshimura
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shimizu
authors.forename: Shigeru
authors.initials: S
authors.lastname: Toyoda
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Nakayama
authors.forename: Kazuie
authors.initials: K
authors.lastname: Iinuma
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000293:Adolescent; D000658:Amoxicillin / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D017291:Clarithromycin / Q000494:pharmacology / Q000627:therapeutic use; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D016481:Helicobacter Infections / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D064747:Lansoprazole; D008795:Metronidazole / Q000494:pharmacology / Q000627:therapeutic use; D008826:Microbial Sensitivity Tests; D009853:Omeprazole / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077402:Pantoprazole; D054328:Proton Pump Inhibitors; D064750:Rabeprazole; D012189:Retrospective Studies; D013454:Sulfoxides / Q000627:therapeutic use
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D001562:Benzimidazoles; D054328:Proton Pump Inhibitors; D013454:Sulfoxides; D064747:Lansoprazole; D008795:Metronidazole; D064750:Rabeprazole; D000658:Amoxicillin; D000077402:Pantoprazole; D017291:Clarithromycin; D009853:Omeprazole