Assessment of Sequential and Standard Triple Therapy in Treatment of Helicobacter pylori Infection in Children Dependent on Bacteria Sensitivity to Antibiotics

Iwańczak, Barbara; Borys-Iwanicka, Agnieszka; Biernat, Monika; Gościniak, Grażyna

doi:10.17219/acem/38554

Cited by 18 publications

(17 citation statements)

References 20 publications

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“…Similar observations were made by researchers from Turkey [ 29 ]. In Poland, due to high resistance to CH (>15%), the empirical use of PPIs, MET and AMO in first-line therapy is a standard treatment, although at our center, attempts at targeted treatment based on results of susceptibility testing have been undertaken for several years [ 30 ]. Multiresistant strains, including those resistant to CH and MET, were detected significantly more frequently in boys with peptic ulcer disease and chronic gastritis than in girls ( p < 0.05).…”

Section: Discussionmentioning

confidence: 99%

Phenotypic and Genotypic Analysis of Resistant Helicobacter pylori Strains Isolated from Children with Gastrointestinal Diseases

Biernat

Bińkowska²,

Łaczmański

et al. 2020

Diagnostics

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Antibiotic resistance of Helicobacter pylori is currently a global issue. The aim of this study was to analyze actual antibiotic resistance rates of H. pylori strains isolated from children with primary infections and to compare the incidence of mutations that determine resistance to clarithromycin (CH) and metronidazole (MET) in children with different clinical diagnoses. A total of 91 H. pylori strains were isolated from 108 children with primary infections. Drug susceptibility testing of the strains was performed using E-test method. Classical sequencing of DNA fragments was used to detect point mutations for CH and MET resistance. Resistance to CH was detected in 31% of isolated strains (28/91), while resistance to MET and CH was detected in 35% (32/91) of strains. A2143G was the most frequently detected mutation and was dominant among strains isolated from children with peptic ulcer disease (80%). Mutations in the rdxA gene were found significantly more frequently among MET-resistant strains than MET-sensitive strains (p = 0.03, Chi2 = 4.3909). In children, a higher frequency of H. pylori multiresistant strains was observed compared with the previous study in the same area. Differences were found in the occurrence of point mutations among H. pylori strains resistant to CH isolated from children with different clinical diagnoses.

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Section: Discussionmentioning

confidence: 99%

Phenotypic and Genotypic Analysis of Resistant Helicobacter pylori Strains Isolated from Children with Gastrointestinal Diseases

Biernat

Bińkowska²,

Łaczmański

et al. 2020

Diagnostics

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“…Iwanczak et al 54 compared the efficiency of a 7-day triple therapy containing clarithromycin (CLA), a 7-day triple therapy containing metronidazole (MET) and a 10-day sequential regimen in a randomized trial. They concluded that eradication rate is influenced by CLA resistance but not by MET resistance.…”

Section: Helicobacter Pylori and Gastric Microbiotamentioning

confidence: 99%

“…Iwanczak et al . compared the efficiency of a 7‐day triple therapy containing clarithromycin (CLA), a 7‐day triple therapy containing metronidazole (MET) and a 10‐day sequential regimen in a randomized trial.…”

Section: Treatmentmentioning

confidence: 99%

Helicobacter pylori infection in children

2017

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Helicobacter pylori infection in children differs from that in adults, from the point of view of epidemiology, host response, clinical features, related diseases, and diagnosis, as well as treatment strategies. The prevalence of H. pylori infection, in both children and adults, is decreasing in the Western World as well as in some developing countries, which contrasts with the increase in childhood asthma and allergic diseases. Recurrent abdominal pain is not specific during H. pylori infection in children. The role of H. pylori infection and failure to thrive, children's growth, type I diabetes mellitus (T1DM) and celiac disease remains controversial. The main initial diagnosis is based on upper digestive endoscopy with biopsy-based methods. Nodular gastritis may be a pathognomonic endoscopic finding of childhood H. pylori infection. The infection eradication control is based on validated noninvasive tests. The main cause of treatment failure of H. pylori infection is its clarithromycin resistance. We recommend standard antibiotic susceptibility testing of H. pylori in pediatric patients prior to the initiation of eradication therapy. H. pylori treatment in children should be based on an evaluation of the rate of eradication in the local population, a systematic use of a treatment adapted to the susceptibility profile and a treatment compliance greater than 90%. The last meta-analysis in children did not show an advantage for sequential therapy when compared to a 14-day triple therapy. Finally, the high rate of antibiotic resistance responsible for therapy failure in recent years justifies the necessity of a novel vaccine to prevent H. pylori infection in children.

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“…There are few randomized controlled trials of H. pylori eradication in children and none in Algeria. During the nineties, eradication rates of 90% were reported, but the efficacy of these first-line treatments, which combine a proton pump inhibitor with two antibiotics, has notably decreased to 70-74% [21], mainly as a result of primary antibiotic resistance of H. pylori strains [22,23] or the lack of therapeutic adherence [24,25]. The most widely used therapeutic scheme in the western world, based on the combination of the proton pump inhibitor omeprazole with 2 antibiotics, amoxicillin and clarithromycin, for 7 days, reaches only a rather disappointing eradication rate of 71% by PP and 68% by ITT analysis [26].…”

Section: Discussionmentioning

confidence: 99%

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

Moubri¹

2018

aog

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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.

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Assessment of Sequential and Standard Triple Therapy in Treatment of Helicobacter pylori Infection in Children Dependent on Bacteria Sensitivity to Antibiotics

Cited by 18 publications

References 20 publications

Phenotypic and Genotypic Analysis of Resistant Helicobacter pylori Strains Isolated from Children with Gastrointestinal Diseases

Phenotypic and Genotypic Analysis of Resistant Helicobacter pylori Strains Isolated from Children with Gastrointestinal Diseases

Helicobacter pylori infection in children

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

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