Helicobacter pylori eradication in childhood after failure of initial treatment: advantage of quadruple therapy with nifuratel to furazolidone.
BACKGROUND
Failures of Helicobacter pylori eradication in children are common.


OBJECTIVE
To evaluate the efficacy of amoxicillin, bismuth subcitrate and omeprazole and nifuratel or furazolidone for H. pylori eradication in children who failed initial treatment with a standard triple therapy.


METHODS
Seventy-six consecutive H. pylori-positive paediatric out-patients (aged 12-16 years; mean age 13.7 +/- 1.4) with chronic abdominal complaints who had failed one attempt of eradication of H. pylori using metronidazole-containing triple therapy were enrolled. It was an open prospective study. Patients were randomized to receive a 2-week course of bismuth subcitrate (8 mg/kg/day, q.d.s.), amoxicillin (50 mg/kg/day, q.d.s.), with either nifuratel (15 mg/kg/day, q.d.s.) or furazolidone (10 mg/kg/day, q.d.s.), plus omeprazole (0.5 mg/kg, once daily).


RESULTS
There were 37 patients in the nifuratel group and 39 in the furazolidone group. Helicobacter pylori was eradicated in 33 of 37 (89%; 95% CI: 74.5-96.9; intention-to-treat) in nifuratel group and in 34 of 39 (87%; 95% CI: 72.5-95.7) in furazolidone group, respectively. Frequency of severe side-effects was greater with furazolidone (21%) than with nifuratel (3%; P = 0.0289).


CONCLUSIONS
Nitrofuran-containing therapies consisting of a proton-pump inhibitor, amoxicillin and bismuth citrate plus either nifuratel or furazolidone produced good cure rates even among those who had failed prior therapy. Nifuratel is preferred because of the lower frequency of side-effects.
Nijevitch
A A
AA
Children's Republican Hospital, Ufa, Russia. aanj@rambler.ru
Shcherbakov
P L
PL
Sataev
V U
VU
Khasanov
R Sh
RSh
Al Khashash
R
R
Tuygunov
M M
MM
D000293:Adolescent; D000658:Amoxicillin / Q000009:adverse effects / Q000627:therapeutic use; D000863:Antacids / Q000009:adverse effects / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D005664:Furazolidone / Q000009:adverse effects / Q000627:therapeutic use*; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D008297:Male; D009545:Nifuratel / Q000009:adverse effects / Q000627:therapeutic use*; D009853:Omeprazole / Q000009:adverse effects / Q000627:therapeutic use; D009942:Organometallic Compounds / Q000009:adverse effects / Q000627:therapeutic use; D010865:Pilot Projects; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D016896:Treatment Outcome
D000863:Antacids; D000900:Anti-Bacterial Agents; D009942:Organometallic Compounds; D054328:Proton Pump Inhibitors; D005664:Furazolidone; D000658:Amoxicillin; C002791:bismuth tripotassium dicitrate; D009853:Omeprazole; D009545:Nifuratel