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| |  Sequential Therapy Has Higher Helicobacter pylori Eradication Rate Than Triple Therapy in Children: Presented at ESPID By Lynda Jackson BRUSSELS, Belgium -- June 12, 2009 -- Sequential treatment for eradicating Helicobacter pylori in children seems highly effective with similar or higher eradication rate than with triple therapy prescribed in accordance with antimicrobial susceptibility, researchers stated here at the 27th Annual Meeting of the European Society for Paediatric Infectious Diseases. Patrick Bontems, MD, Gastroenterology-Hepatology, Queen Fabiola Children’s University Hospital, Brussels, Belgium, presented the findings here on June 11. According to Dr. Bontems, H pylori is recognised as a widespread pathogen causing gastric ulcer disease and gastric cancers. Treatment is a problem and eradication rates are at the lowest levels seen. Dr. Bontems and colleagues assessed the eradication rate using a sequential regimen containing a triple therapy compared with the standard omeprazole-containing triple therapy. The study also evaluated the impact of eradication on H pylori resistance. A total of 98 children aged 1 to 17 years with non-ulcer dyspeptic manifestations were enrolled in the multicentre prospective study. Infection was proven by histology and culture, and children received no anti-H pylori drugs during 4 weeks. Patients were randomised to receive either 10 days of sequential treatment consisting of omeprazole-amoxicillin for 5 days and omeprazole-clarithromycin-metronidazole for the remaining 5 days or to a 7-day treatment consisting of omeprazole-amoxicillin plus clarithromycin when strains were susceptible to clarithromycin, or plus metronidazole in case of resistance to clarithromycin. H pylori eradication was assessed by 13C-urea breath test at least 8 weeks after treatment. Eradication was achieved in 74 children out of 88 who returned for a follow-up test. Intention-to-treat (ITT) eradication rate was 76% (10-day 41/55 >=75%; 7-day 33/43 77%) and per-protocol (PP) cure rate was 84% (10-day 41/49 84%; 7-day 33/39 >=85%). When clarithromycin resistance was present, ITT eradication rate was 9/14 (7/12 in patients receiving the 10-day therapy; 2/2 in patients receiving the 7-day therapy). PP cure rate was 9/13 (10-day therapy, 7/11; 7-day therapy, 2/2) When metronidazole resistance was present, ITT eradication was 13/18 (9/13 patients receiving the 10-day therapy; 4/5 patients receiving the 7-day therapy). PP was 13/15 (10-day therapy 9/10; 7-day therapy, 4/5). Sequential treatment seems highly effective for eradicating H pylori with similar or higher eradication rate than with triple therapy prescribed in accordance with antimicrobial susceptibility. However in cases of clarithromycin or metronidazole resistance, the cure rate is decreased. Sequential treatment may be used as a first-line therapy if an antibiotic susceptibility test is not available but only in populations with low clarithromycin, according to Dr. Bontems. [Presentation title: Sequential Therapy vs Standard Triple Therapies for Helicobacter Pylori Infection in Children. Abstract P002]
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