Efficacy of the standard quadruple therapy versus triple therapies containing proton pump inhibitor plus amoxicillin and clarithromycin or amoxicillin-clavulanic acid and metronidazole for Helicobacter pylori eradication in children.
OBJECTIVE
Helicobacter pylori (H. pylori) cure rates vary in different geographical regions because of differences in hosts as well as in H. pylori strains. In this study we evaluated the efficacy of different treatment regimens for eradication of H. pylori infection in children, in order to select a treatment regimen that is most effective with the least adverse effects and cost.


METHODS
Through a randomized clinical trial study we enrolled 120 pediatric patients (age <or= 18 years) with H. pylori infection confirmed through histopathological examination of their upper endoscopic findings and positive rapid urease test. Patients were randomized into three groups: group A received omeprazole, amoxicillin, metronidazole, and bismuth subcitrate; group B received omeprazole, amoxicillin, and clarithromycin; and group C the most recent regime of omeprazole, amoxicillin-clavulanic acid, and metronidazole. Subjects were followed 6 weeks after completing the antimicrobial therapy and H. pylori eradication was assessed with urea breath test.


RESULTS
A total of 117 patients with a mean age of 12 +/- 4 years completed the study. Eradication rate was 91.9% in group A, compared with 82.1% in group B, and 80.5% in group C (P = 0.33).


CONCLUSIONS
Considering these data we suggest quadruple therapy as the first line of therapy for eradication of H. pylori infection in children in our geographic area (Iran).
Dehghani
Seyed Mohsen
SM
Gastroenterohepatology Research Center, Pediatric Gastroenterology Department, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, 71937-11351, Iran. dehghanism@sums.ac.ir
Erjaee
Asma
A
Imanieh
Mohammad Hadi
MH
Haghighat
Mahmood
M
D000293:Adolescent; D000658:Amoxicillin / Q000009:adverse effects / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001944:Breath Tests; D002648:Child; D002675:Child, Preschool; D017291:Clarithromycin / Q000009:adverse effects / Q000627:therapeutic use*; D019818:Clavulanic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000208:ethnology / Q000378:metabolism; D016480:Helicobacter pylori; D006801:Humans; D007492:Iran; D008297:Male; D008795:Metronidazole / Q000009:adverse effects / Q000627:therapeutic use*; D009853:Omeprazole / Q000009:adverse effects / Q000627:therapeutic use; D009942:Organometallic Compounds / Q000009:adverse effects / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016037:Single-Blind Method; D016896:Treatment Outcome; D014508:Urea / Q000378:metabolism
D000900:Anti-Bacterial Agents; D009942:Organometallic Compounds; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D019818:Clavulanic Acid; D000658:Amoxicillin; D014508:Urea; D017291:Clarithromycin; C002791:bismuth tripotassium dicitrate; D009853:Omeprazole