title: Effectiveness of sequential v. standard triple therapy for treatment of Helicobacter pylori infection in children in Nairobi, Kenya.
abstract: BACKGROUND
  Once the diagnosis of Helicobacter pylori is confirmed, treatment requires at least two antibiotics and an acid inhibitor for a minimum of seven days. Unfortunately, treatment failures are being frequently reported. Treatment regimens that include sequential administration of antibiotics with acid inhibitors have been developed to try and increase the rate of eradication.
  
  
  OBJECTIVE
  To determine the effectiveness of a novel 10-day sequential therapy compared with the standard 10-day triple therapy for treatment of H. pylori infection in children.
  
  
  METHODS
  A double-blinded, randomised, controlled trial was conducted. Children under the age of 16 years with recurrent abdominal pain associated with dyspepsia and diagnosed with H. pylori by histology were randomly allocated either to a 10-day sequential treatment regimen or to a 10-day conventional triple therapy. Analysis of the outcome of this study was based on clinical improvement and confirmed H. pylori eradication based on stool H. pylori antigen detection and/or repeat endoscopy.
  
  
  RESULTS
  Of the 71 patients included in the analysis, 45 (63.4%) were given the 10-day conventional treatment while 26 (36.6%) received the 10-day sequential treatment. There was no difference in clinical improvement after treatment in the two therapies. However, there was a significant difference in the eradication of H. pylori between the conventional v. sequential regimens (48.8% v. 84.6%, respectively; p=0.02, odds ratio 0.19).
  
  
  CONCLUSIONS
  The sequential treatment had a significantly higher H. pylori eradication rate than the conventional treatment.
authors.affiliation: Department of Paediatrics and Child Health, University of Nairobi, Kenya; Department of Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya. arlaving@yahoo.com.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Laving
authors.forename: Rose
authors.initials: R
authors.lastname: Kamenwa
authors.forename: Shahin
authors.initials: S
authors.lastname: Sayed
authors.forename: Andrew Nyerere
authors.initials: AN
authors.lastname: Kimang'a
authors.forename: Gunturu
authors.initials: G
authors.lastname: Revathi
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000658:Amoxicillin / Q000008:administration & dosage / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D017291:Clarithromycin / Q000008:administration & dosage / Q000009:adverse effects; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D004415:Dyspepsia / Q000209:etiology; D005243:Feces / Q000382:microbiology; D005260:Female; D005773:Gastroscopy / Q000379:methods; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D016480:Helicobacter pylori / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D007630:Kenya; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D000658:Amoxicillin; D017291:Clarithromycin