Adapted first-line treatment of Helicobacter pylori infection in Algerian children

Abstract

BackgroundHelicobacter pylori (H. pylori) infection is acquired in early life and continues to have a high prevalence, especially in developing countries. Growing antibiotic-resistant strains necessitate adapted treatments. This study aimed to compare the efficacy, side effects, and influence of resistance of H. pylori strains between two different treatments.MethodsThis prospective, randomized blind study enrolled 112 symptomatic children infected with H. pylori (66 girls, mean age 11.1 years). Treatments, allocated randomly irrespective of the susceptibility of the strains, were either the standard omeprazole–amoxicillin–clarithromycin combination for 7 days (OAC7; group A) or omeprazole–amoxicillin with a higher dose of metronidazole (40 instead of 20 mg/kg/d) for 10 days (OAM10; group B).ResultsBefore treatment, the resistance rates of H. pylori strains to metronidazole or clarithromycin were 37% and 13%, respectively, with 7% resistant to both antibiotics and neither to amoxicillin. Eradication rates obtained with OAM10 (80% by intention-to-treat [ITT] and 88% by per protocol [PP] analysis) were higher than with OAC7 (68% in ITT and 71% PP) and the differences (12% in ITT and 17% PP) were statistically significant (P=0.03). Successful treatments with OAM10 were obtained in metronidazole resistant strains and were more effective in children aged >10 years (P=0.02 by ITT and P=0.04 by PP). Only light or moderate side effects, mainly digestive, were observed.ConclusionBecause of its therapeutic efficacy, good tolerance and lower cost the OAM10 can be considered as an appropriate first-line therapeutic scheme in Algeria.

Helicobacter pylori infection in children

“…27 Studies demonstrated that triple therapy with PPI-AMO-CLA offers acceptable eradication rates when the strains are sensitive, and the resistance to MET does not significantly influence eradication. [32][33][34] Authors reported patients with susceptibilityguided treatment with adherence >90% of treatment achieved acceptable rates of eradication, 30 35 the rates were significantly higher in those receiving sequential therapy. 35 High doses of MET with triple therapy for 10 days in patients without culture improved eradication rates, although the desired ones were not achieved.…”

Review: Helicobacter pylori in pediatrics

“…The prevalence of H pylori resistant to antibiotics differs among countries (Table ) and is usually explained by the different exposure to the corresponding antibiotics in each population . First‐line treatment should, therefore, be tailored according to the strain's susceptibility or, if tests are not available, at least according to the regional antibiotic resistance rates of H pylori strains …”

“…Apart from high H pylori resistance to antimicrobial agents, there are other reasons for therapeutic failure, such as poor compliance, inadequate dose/duration, rapid metabolism of certain PPI, bacterial virulence factors, ineffective penetration of antibiotics into gastric mucosa, and antibiotic inactivation to low gastric pH …”

“…This past year reported eradication rates ranged from 60% in China (with a 14‐day standard therapy) to 97.8% in Portugal with a 14‐day tailored therapy (Table ).…”

“…In order to improve therapeutic efficacy, different treatment modalities have been studied. Two prospective randomized trials were performed; however, none was in line with current guidelines concerning dosages and treatment duration …”