Eradication therapy for Helicobacter pylori infection based on the antimicrobial susceptibility test in children: A single‐center study over 12 years

Abstract

Background Helicobacter pylori (H. pylori) infection causes chronic gastritis, duodenal and to a lesser extent, gastric ulcers, and gastric cancer. Most H. pylori infections are acquired in childhood, and effective treatment of childhood infection is very important. Esophagogastroduodenoscopy (EGD) is useful for endoscopic diagnosis, mucosal tissue biopsy, and culture examination for H. pylori in children and adults. In this paper, we report results of susceptibility tests and eradication rates in H. pylori‐positive children who underwent EGD over a 12‐year period. Materials and Methods The subjects were H. pylori‐positive pediatric patients who had gastrointestinal symptoms and underwent EGD in the Department of Pediatrics, Juntendo University Hospital (January 2007–December 2018). Patients underwent serum IgG antibody tests, fecal antigen tests, or urea breath tests, and subsequently, culture tests by gastric mucosal biopsy during EGD. H. pylori positivity was defined as a positive result on both tests. Patients received triple therapy for 14 days using our regimen, and eradication was assessed at 2, 6, and 12 months after therapy. Results Forty‐five patients were H. pylori‐positive, and the overall clarithromycin (CAM) resistance rate was 71.1 % (32/45). The CAM resistance rate for the 2013–2018 period was significantly higher than the 2007–2012 period (52.6% vs. 84.6%, P < 0.05). According to the results of the antimicrobial susceptibility test, we prescribed effective antibiotics, and this resulted in a primary eradication rate of 97.7%. Conclusions We suggest that antimicrobial susceptibility testing can significantly improve rates of primary eradication of H. pylori infection.

Efficacy of Phenotype-vs. Genotype-Guided Therapy Based on Clarithromycin Resistance for Helicobacter pylori Infection in Children

“…Thirteen studies investigating the effectiveness of culture-based tailored therapy in children are shown in Table 1 . The eradication rate was over 90% in five studies ( 9 , 11 , 17 , 20 , 21 ) but ranged from 70 to 90% in the other eight studies ( 10 , 12 – 16 , 18 , 19 ). For the tailored therapy based on molecular tests with gastric biopsy, there is a paucity of data for children, though the eradication rate in most adult studies was over 90% ( 22 – 25 ).…”

Aktualisierte S2k-Leitlinie Helicobacter pylori und gastroduodenale Ulkuskrankheit der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – Juli 2022 – AWMF-Registernummer: 021–001

“…Bei Einnahme von mindestens 90 % der verschriebenen Dosen erhöhte sich die Heilungsrate auf 93 %. Ergebnisse aus Slowenien [541] und Japan [517] bestätigen die hohen Erfolgsraten der am Antibiogramm orientierten Dreifachtherapie. Bei einem Vergleich vier verschiedener Therapieregime bei Kindern in China, wurden nur mit einer Bismut-basierten Vierfachtherapie Eradikationsraten von 90 % erreicht, während die Standard-Tripletherapie, die sequentielle Therapie und die konkomitante Therapie mit 74 %, 69 % und 85 % das Ziel verfehlten [512].…”

“…als fixe Kombination in Form von Pylera nur außerhalb der Zulassung und wegen des Tetrazyklin-Anteils nur für Jugendliche zur Verfügung. Eine sogenannte "Tailored Triple Therapy" (TTT) über 14 Tage, die sich an den Ergebnissen der antibiotischen Resistenztestung aus den Magenbiopsien orientiert, ist daher bei Kindern und Jugendlichen die Therapie der ersten Wahl [464,511,517] (siehe ▶ Abb. 5).…”

AcrB is essential for bile acid tolerance in Helicobacter pylori

“…In many developing countries it infects about 80% of the population and in developed countries it infects about 30% [2,3]. H. pylori plays an important role in the pathogenesis of chronic gastritis, peptic ulcer diseases, gastric carcinomas, and gastric marginal zone B-cell lymphomas of mucosa-associated lymphoid tissue type [4,5,6,7].…”