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Sequential Therapy for Helicobacter pylori Infection in Treatment‐naïve Children
Author(s) -
Schwarzer Andrea,
Bontems Patrick,
Urruzuno Pedro,
Kalach Nicolas,
Iwanczak Barbara,
RomaGiannikou Elefteria,
Sykora Josef,
Kindermann Angelika,
Casswall Thomas,
Cadranel Samy,
Koletzko Sibylle
Publication year - 2016
Publication title -
helicobacter
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 79
eISSN - 1523-5378
pISSN - 1083-4389
DOI - 10.1111/hel.12240
Subject(s) - esomeprazole , clarithromycin , metronidazole , medicine , amoxicillin , helicobacter pylori , gastroenterology , antibiotics , antibiotic resistance , microbiology and biotechnology , biology
The goal of first‐line H elicobacter pylori therapy is to reach an eradication rate of 90% to avoid further investigations, antibiotic use, and spreading of resistant strains. Aim 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 OR s 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). Conclusion A high‐dose 10‐day sequential therapy cannot be recommended in treatment‐naïve children.