title: Eradication of Helicobacter pylori in children in Vietnam in relation to antibiotic resistance.
abstract: BACKGROUND
  Low Helicobacter pylori eradication rates are common in pediatric trials especially in developing countries. The aim of the study was to investigate the role of antibiotic resistance, drug dosage, and administration frequency on treatment outcome for children in Vietnam.
  
  
  METHODS
  Antibiotics resistance of H. pylori was analyzed by the Etest in 222 pretreatment isolates from children 3-15 years of age who were originally recruited in a randomized trial with two treatment regiments: lansoprazole with amoxicillin and either clarithromycin (LAC) or metronidazole (LAM) in two weight groups with once- or twice-daily administration. The study design was an observational study embedded in a randomized trial.
  
  
  RESULTS
  The overall resistance to clarithromycin, metronidazole, and amoxicillin was 50.9%, 65.3%, and 0.5%, respectively. In LAC, eradication was linked to the strains being susceptible to clarithromycin (78.2% vs 29.3%, p = .0001). Twice-daily dosage of proton-pump inhibitor (PPI) and clarithromycin was more effective for eradication than once-daily dosage for resistant strains (50.0% vs 14.7%, p = .004) and tended to be so also for sensitive strains (87.5% vs 65.2%, p = .051). Exact antibiotic dose per body weight resulted in more eradication for resistant strains (45.3% vs 8.0%, p = .006). These differences were less pronounced for the LAM regimen, with twice-daily PPI versus once daily for resistant strains resulting in 69.2% and 50.0% eradication (p = .096), respectively.
  
  
  CONCLUSIONS
  Helicobacter pylori clarithromycin resistance was unexpectedly high in young children in Vietnam. Clarithromycin resistance was an important cause for eradication treatment failure. Twice-daily administration and exact antibiotic dosing resulted in more eradicated infections when the strains were antibiotic resistant, which has implications for the study design in pediatric H. pylori eradication trials.
authors: Department of Pediatrics, Hanoi Medical University and National Hospital of Pediatrics, Hanoi, Vietnam.
authors: Thi Viet Ha
authors: TV
authors: Nguyen
authors: Carina
authors: C
authors: Bengtsson
authors: Li
authors: L
authors: Yin
authors: Gia Khanh
authors: GK
authors: Nguyen
authors: Thi Thu Ha
authors: TT
authors: Hoang
authors: Dac Cam
authors: DC
authors: Phung
authors: Mikael
authors: M
authors: Sörberg
authors: Marta
authors: M
authors: Granström
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000494:pharmacology / Q000627:therapeutic use; D000293:Adolescent; D000658:Amoxicillin / Q000494:pharmacology / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D017291:Clarithromycin / Q000494:pharmacology / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D016480:Helicobacter pylori / Q000187:drug effects* / Q000302:isolation & purification / Q000502:physiology; D006801:Humans; D064747:Lansoprazole; D008297:Male; D014744:Vietnam / Q000453:epidemiology
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000900:Anti-Bacterial Agents; D064747:Lansoprazole; D000658:Amoxicillin; D017291:Clarithromycin