title: Sequential Therapy for Helicobacter pylori Infection in Treatment-naïve Children.
abstract: The goal of first-line Helicobacter pylori therapy is to reach an eradication rate of 90% to avoid further investigations, antibiotic use, and spreading of resistant strains.
  
  
  OBJECTIVE
  To evaluate the eradication rate of high-dose sequential therapy in treatment-naïve children and to assess factors associated with failure.
  
  
  METHODS
  Prospective data assessed in a registry from nine European centers between October 2009 and December 2011. Children with biopsy-proven Helicobacter pylori infection were prescribed 5 days of esomeprazole and amoxicillin, followed by 5 days of esomeprazole, clarithromycin, and metronidazole according to bodyweight. Eradication was assessed after 8-12 weeks. Primary endpoint was the eradication rate in children who received at least one dose and had follow-up data. Multivariate analysis evaluated potential factors for treatment success including sex, age, center, migrant status, antibiotic resistance, and adherence to therapy.
  
  
  RESULTS
  Follow-up was available in 209 of 232 patients (age range 3.1-17.9 years, 118 females). Primary resistance occurred for clarithromycin in 30 of 209 (14.4%), for metronidazole in 32 (15.3%), for both antibiotics in 7 (3.3%), and culture failed in 6 (2.9%). Eradication was achieved in 168 of 209 children (80.4%, 95% CI 75.02-85.78), in 85.8% with no resistance, 72.6% with single resistance, and 28.6% with double resistance. Independent factors affecting eradication rate included resistance to clarithromycin (adjusted ORs 0.27 (0.09-0.84), p = .024), to metronidazole (0.25 (0.009-0.72), p = .010) or to both (0.04 (0.01-0.35), p = .004), and intake of ≤ 90% of prescribed drugs (0.03 (0.01-0.18), p < .001).
  
  
  CONCLUSIONS
  A high-dose 10-day sequential therapy cannot be recommended in treatment-naïve children.
authors.affiliation: Dr. v. Haunersches Kinderspital, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Schwarzer
authors.affiliation: Department of Pediatric Gastroenterology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Bontems
authors.affiliation: Hospital de 12 Octobre, Madrid, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Urruzuno
authors.affiliation: Saint Antoine Pediatric Clinic, Saint Vincent de Paul Hospital, Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Catholic University, Lille, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Kalach
authors.affiliation: Department of Pediatrics, Medical University of Wrocław, Wrocław, Poland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Iwanczak
authors.affiliation: 1st Department of Paediatrics of Athens University, Athens, Greece.
authors.forename: Elefteria
authors.initials: E
authors.lastname: Roma-Giannikou
authors.affiliation: Department of Paediatrics, Faculty Hospital, Charles University, Plezn, Czech Republic.
authors.forename: Josef
authors.initials: J
authors.lastname: Sykora
authors.affiliation: Department of Pediatric Gastroenterology, Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Angelika
authors.initials: A
authors.lastname: Kindermann
authors.affiliation: Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Casswall
authors.affiliation: Department of Pediatric Gastroenterology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Samy
authors.initials: S
authors.lastname: Cadranel
authors.affiliation: Dr. v. Haunersches Kinderspital, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Sibylle
authors.initials: S
authors.lastname: Koletzko
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000379:methods; D005060:Europe; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013995:Time; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic resistance; children; clarithromycin; metronidazole