Comparison of Sequential and Standard Therapy for Helicobacter pylori Eradication in Children and Investigation of Clarithromycin Resistance

• DOI: 10.1097/mpg.0b013e3182575f9c
• Publication Date: 2012-03-29T09:17:46Z
• Authors: Baris Erdur; Yesim Ozturk; Ebru D. Gurbuz; Ozlem Yilmaz
• Keywords: Adolescent; Helicobacter pylori; Amoxicillin; Anti-Ulcer Agents; 2-Pyridinylmethylsulfinylbenzimidazoles; Anti-Bacterial Agents; Helicobacter Infections; 3. Good health; Child, Preschool; Clarithromycin; Humans; Drug Therapy, Combination; Lansoprazole; Child

The aim of the present study was to compare the efficacy of sequential and standard triple-drug regimen for Helicobacter pylori (H pylori) eradication in children and to determine the primary resistance rate to clarithromycin.Children with H pylori infection randomized to receive either standard regimen (n = 28) consisting of lansoprazole for 30 days, amoxicillin and clarithromycin for 14 days or sequential regimen (n = 16) consisting of lansoprazole for 30 days, amoxicillin for 7 days, followed by clarithromycin and metronidazole for the next 7 days. Clarithromycin susceptibility of H pylori was assessed with fluorescence in-situ hybridization technique. Eradication was controlled by C urea breath test or monoclonal stool antigen test 4 weeks after the end of the therapy.H pylori eradication rate was higher in the sequential therapy group (93.7%), compared with the standard therapy group (46.4%) (P = 0.002). There was no difference in adverse drug reactions and in compliance to the treatment between the groups. Primary clarithromycin resistance rate for H pylori was found as 25.7% (n = 9). All of the patients having clarithromycin resistance were coincidentally in the standard therapy group. After the exclusion of these 9 patients, sequential therapy was again found to be more effective than the standard therapy (P = 0.02).Sequential therapy seems highly effective for eradicating H pylori in children; however, the difference between 2 groups in resistant strains was the limitation of the study. Our country needs to reassess the effectiveness of standard triple therapy regimen for H pylori eradication.