Results of triple eradication therapy in Japanese children: a retrospective multicenter study

Kato, Seiichi; Konno, Mutsuko; Maisawa, Shunichi; Tajiri, Hitoshi; Yoshimura, Norikazu; Shimizu, Toshiaki; Toyoda, Shigeru; Nakayama, Yoshiko; Iinuma, Kazuie

doi:10.1007/s00535-004-1398-6

Cited by 43 publications

(59 citation statements)

References 24 publications

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“…Indeed, eradication rates in children treated with a first-line regimen of PPI, AMPC and CAM are also decreasing related to increased antibiotic resistance especially to CAM. In the past, multicenter studies in Japan reported H. pylori eradication rates in children achieving with PPI, AMPC and CAM were 70.6% to 77.4% [39] [41]. Consistent with previous studies in adults, the eradication rate has decreased in pediatric patients infected with CAM resistant strains to 40.0% -57.1% [37] [39].…”

Section: Discussionsupporting

confidence: 63%

“…In the past, multicenter studies in Japan reported H. pylori eradication rates in children achieving with PPI, AMPC and CAM were 70.6% to 77.4% [39] [41]. Consistent with previous studies in adults, the eradication rate has decreased in pediatric patients infected with CAM resistant strains to 40.0% -57.1% [37] [39]. Since the goal of treatment is at least a 90% eradication rate on a per-protocol basis at the first attempt [45], recent eradication rate of the firstline therapy with PPI, AMPC and CAM strongly suggests the need for new approaches.…”

Section: Discussionmentioning

confidence: 99%

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Antibiotic Resistance of Helicobacter pylori and Eradication Rate in Japanese Pediatric Patients

Ikuse¹,

Aoyagi²,

Obayashi³

et al. 2017

AiM

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Helicobacter pylori (H. pylori) eradication rates achieved with a proton pump inhibitor (PPI), amoxicillin and clarithromycin have recently decreased to about 75% because of the increase in clarithromycin resistance in Japan. In the present study, H. pylori resistance rates against clarithromycin, amoxicillin and metronidazole were investigated in pediatric patients and eradication rates were evaluated when tailored antibiotics regimens based on antibiotic sensitivity data were used. We isolated H. pylori endoscopically from 77 pediatric patients suffering from abdominal symptoms. The susceptibility tests of H. pylori strains to clarithromycin, amoxicillin and metronidazole were examined and eradication therapy was tailored using the appropriate antibiotics. Seventy-seven patients were treated with a mean age of 12.16 ± 3.34 years (range, 4.92 -19.75) consisting of 40 males and 37 females. The average resistance rates between 1998 and 2016 to clarithromycin, amoxicillin and metronidazole were 54.5% (42 of 77), 6.5% (5 of 77) and 5.2% (4 of 77) respectively. The prevalence of clarithromycin resistance increased significantly over time to reach 88.9% by 2013-2016. Successful eradication rates using tailored antibiotic treatment was 93.8% (61 of 65). Clarithromycin-based eradication therapy rate reached 92.6% against clarithromycin-sensitive strains. Metronidazole-based initial eradication therapy also had a high successful rate (97.0%) to clarithromycin-resistant strains. Although high rates of clarithromycin resistant H. pylori reaching about 90% were observed in Japanese children, tailored eradication therapy using the appropriate antibiotic agents were highly successful. H. pylori sensitivity testing and eradication therapy with appropriate antibacterial agents may contribute to accomplishment of high initial eradication rates and consequently reducing the incidence of developing gastric cancer.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Antibiotic Resistance of Helicobacter pylori and Eradication Rate in Japanese Pediatric Patients

Ikuse¹,

Aoyagi²,

Obayashi³

et al. 2017

AiM

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“…The most commonly tested regimen contained a combination of PPI, clarithromycin, and amoxicillin, followed by triple therapies containing PPI, clarithromycin, and nitroimidazoles, or bismuth, clarithromycin, and nitroimidazoles (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). The reasons for the great variability of the eradication rates observed in the studies include small sizes of study populations, differences between study populations, and variation in the total daily dose, dosing frequency and duration of treatment components, as well as in time of posttreatment follow-up and methods used to assess eradication after treatment.…”

Section: Resultsmentioning

confidence: 99%

“…At present, in the pediatric population, five randomized studies have evaluated whether consumption of probiotics could increase H. pylori eradication rates and reduce the side effects of treatment (36)(37)(38)(39)(40).These trials do not provide evidence on the beneficial effect in children of supplementation of probiotics to triple therapy for eradicating H. pylori infection nor for positively (16,19,(43)(44)(45)(46) S: sensitive; R: Resistant affecting therapy-related symptoms and overall treatment tolerance. However, the five studies are all based on relatively small samples and lack the statistical power necessary to detect an important effect of the probiotics.…”

Section: Finland! Multicentermentioning

confidence: 99%

Helicobacter Pylori Therapy in Children: Overview and Challenges

Chiesa

Pacifico

Anania

et al. 2010

Int J Immunopathol Pharmacol

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Helicobacter pylori is one of the most common infections found in humans. It was first identified in 1982 and by 1989 had been associated with gastric inflammation and ulcers in adults and children. During the 1990's evidence emerged of its etiologic role in stomach cancers in adults. That the infection is common and may have serious consequences, has led to an avalanche of research during the last twenty years. During this time, there have been many studies on children which have sought an effective and safe treatment to eradicate the infection, but as yet, no therapy regimen has been found which is always effective and safe. This article provides information, from a pediatric point of view, on the major developments in the therapeutics and therapy of H. pylori infection. It examines first-line treatment regimens, evaluates the efficacy of the main drugs used in the management of (primary) H. pylori infection in children, assesses the potential for the use of probiotics and sequential therapy, examines therapeutic options after failure of initial treatment, and discusses factors affecting eradication rate, including antibiotic resistance, adherence to therapy, and bacterial factors.

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“…At this moment, in Europe only omeprazole and esomeprazole are approved [18]. Almost all published efficacy studies in pediatric patients have been performed with omeprazole and lansoprazole [19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37] used in combination therapies for the first-line treatment of H. pylori eradication. The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition published clinical practice guidelines on the use of omeprazole for management of gastroesophageal reflux disease in infants and children [38].…”

Section: Ppi For H Pylori Eradicationmentioning

confidence: 99%

Helicobacter pylori Therapy in Children: A Focus on Proton Pump Inhibitors

et al. 2011

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Over the last two decades, there have been many studies on children who have sought an effective and safe treatment to eradicate Helicobacter pylori infection, but as yet, no therapy regimen has been found which is always effective and safe. Differences in drug response among pediatric patients are common. Such individual variability in drug response is multifactorial, including environmental, genetic, development and disease determinants that affect the disposition of a given drug. In pediatric efficacy studies for the management of H. pylori eradication in children, the most commonly tested regimen has contained a combination of proton pump inhibitor (PPI), clarithromycin and amoxicillin, followed by triple therapies containing PPI, clarithromycin and nitroimidazoles. Thus, PPIs are an integral part of triple therapy for H. pylori eradication in children with gastroduodenal disease. In this article, we comprehensively review, from a pediatric point of view, the literature on the clinical, pharmacologic and microbiologic properties of PPIs. We also discuss genetic, developmental and other host-related factors that may affect the efficacy of these drugs. Finally, we provide some guidance regarding their potential role and limitations for H. pylori eradication in children.

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Results of triple eradication therapy in Japanese children: a retrospective multicenter study

Abstract: The PAC regimen is effective in children. Clarithromycin resistance is associated with eradication failure. Metronidazole is a good substitute for clarithromycin as the second-line option for children.

Cited by 43 publications

References 24 publications

Antibiotic Resistance of <i>Helicobacter pylori</i> and Eradication Rate in Japanese Pediatric Patients

Antibiotic Resistance of <i>Helicobacter pylori</i> and Eradication Rate in Japanese Pediatric Patients

Helicobacter Pylori Therapy in Children: Overview and Challenges

<i>Helicobacter pylori</i> Therapy in Children: A Focus on Proton Pump Inhibitors

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Results of triple eradication therapy in Japanese children: a retrospective multicenter study

Abstract: The PAC regimen is effective in children. Clarithromycin resistance is associated with eradication failure. Metronidazole is a good substitute for clarithromycin as the second-line option for children.

Cited by 43 publications

References 24 publications

Antibiotic Resistance of &lt;i&gt;Helicobacter pylori&lt;/i&gt; and Eradication Rate in Japanese Pediatric Patients

Antibiotic Resistance of &lt;i&gt;Helicobacter pylori&lt;/i&gt; and Eradication Rate in Japanese Pediatric Patients

Helicobacter Pylori Therapy in Children: Overview and Challenges

<i>Helicobacter pylori</i> Therapy in Children: A Focus on Proton Pump Inhibitors

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Product

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Antibiotic Resistance of <i>Helicobacter pylori</i> and Eradication Rate in Japanese Pediatric Patients

Antibiotic Resistance of <i>Helicobacter pylori</i> and Eradication Rate in Japanese Pediatric Patients