If this is not your name, click here.
| | If this is not your name, click here. | | |
| | Contact Us | Order Now | Journals | Bookstore | Register a colleague | | |
| |  DG DISPATCH - WCPGHN: Pediatric Antibiotic Resistance A Consideration In H Pylori Triple Therapy By Maria Bishop Special to DG News
BOSTON, MA -- August 9, 2000 -- In a comparison study of two different, PPI-based triple-therapy regimens for eradication of Helicobacter pylori (H pylori) in children, a research team from Slovenia and Croatia suggests that pediatric resistance to the antibiotic erythromycin makes a triple therapy with azithromycin more effective. Results of this randomized, prospective study were presented at the first World Congress of Pediatric Gastroenterology, Hepatology and Nutrition in Boston, MA. Proton-pump inhibitor (PPI)-based triple regimens are only now being used to treat eradication of H pylori in children, and their effectiveness has not yet been thoroughly established. Led by Dusica Micetic-Turk, MD, researchers attempted to assess the efficacy of two ten-day regimens in 55 participants. Dr. Micetic-Turk, pediatric gastroenterologist, Maribor General Hospital in Maribor, Slovenia, recruited patients who had symptoms suggestive of an organic disorder of the upper-gastrointestinal (GI) tract. These patients underwent endoscopy, and H pylori infection was diagnosed by culture, microscopy and 13-C urea breath test (UBT). Fifty-five participants were then randomised to one of two treatment groups. Group A received pantoprazole for ten days, metronidazole for ten days and erythromycin for five days. Group B received pantoprazole, metronidazole and azithromycin, all for ten days. Four weeks after completing the therapies, each group was reassessed by UBT, and eradication of H pylori had been achieved in 65 percent of group-A patients and 100 percent of group-B patients. There were no major side effects in either group. Because the difference in the two therapies had been so significant, 25 patients were given resistance tests (enzyme tests) for metronidazole and azithromycin (and amoxicillin as a control). Twenty percent of the children were found to be resistant to azithromycin, while 24 percent were resistant to metronidazole. All strains naturally proved sensitive to amoxicillin. The excellent eradication rate achieved by group B in this comparison study suggests that pediatric resistance to erythromycin makes a triple therapy with azithromycin more effective in the treatment of H pylori in children. Infection with H pylori generally occurs in childhood. Even though antibodies are produced, infection is sustained throughout one’s life. The mechanism of transmission of H pylori is uncertain; however, the fecal-oral route is most likely and oral-oral transmission is also probable. H pylori has been identified as the most important etiologic agent in the development of peptic-ulcer disease. Its eradication can lead to a recurrence rate of less than 5 percent in one year.
|
