Evaluation of triple and quadruple Helicobacter pylori eradication therapies in Iranian children: a randomized clinical trial

Bahremand, Shahla; Nematollahi, Laleh Razavi; Fourutan, Hossein; Tirgari, Farrokh; Nouripour, Shamsollah; Mir, Elham; Aghakhani, Shahriar

doi:10.1097/00042737-200605000-00009

Cited by 20 publications

(21 citation statements)

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“…A similar study done by Kato et al in Japanese children showed eradication rates of 87.5% for proton pump inhibitors (PPI), amoxicillin, and metronidazole, and 77.4% for PPI, amoxicillin, and clarithromycin [13]. However in 2004 Bahremand et al preformed a study in Tehran, Iran, that showed eradication rates of 92% for omeprazole, clarithromycin, and amoxicillin and 84% for omeprazole, amoxicillin, metronidazole, and bismuth subcitrate, thus suggesting PPI, amoxicillin, and clarithromycin triple therapy as first-line eradication treatment in Iranian children [14]. Many studies preformed in adult populations have showed regimes containing amoxicillin-clavulanic acid to be more effective than those with amoxicillin in treatment of H. pylori infection [9,10,15]; however we found no similar study previously preformed in pediatric age groups elsewhere, and our study seems to be the first to have preformed such a comparison.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of the Standard Quadruple Therapy Versus Triple Therapies Containing Proton Pump Inhibitor Plus Amoxicillin and Clarithromycin or Amoxicillin-Clavulanic Acid and Metronidazole for Helicobacter pylori Eradication in Children

et al. 2008

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Section: Discussionmentioning

confidence: 99%

Efficacy of the Standard Quadruple Therapy Versus Triple Therapies Containing Proton Pump Inhibitor Plus Amoxicillin and Clarithromycin or Amoxicillin-Clavulanic Acid and Metronidazole for Helicobacter pylori Eradication in Children

et al. 2008

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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%

“…These guidelines have been extrapolated in pediatric efficacy studies for the management of H. pylori eradication in children. In fact, similar dose regimens have applied to omeprazole- (and lansoprazole-) based dual and triple eradication therapies for H. pylori in children [19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37]. …”

Section: Ppi For H Pylori Eradicationmentioning

confidence: 99%

“…In addition, twice daily PPI therapy has not been tested in appropriately designed trials with clinically significant endpoints [14]. Nonetheless, twice daily PPI therapy has been the rule in most pediatric efficacy studies for H. pylori eradication [19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37]. Although extending PPI dose timing may be attractive to some investigators, this PPI schedule may challenge the child’s and adolescent’s adherence to the medication [4], which may be important in determining clinical outcomes.…”

Section: Pharmacological Propertiesmentioning

confidence: 99%

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<i>Helicobacter pylori</i> 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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“…The authors suggested quadruple therapy as the first-line of therapy for the eradication of H. pylori infection in children in their geographic area. Treatment of H. pylori infection in children with protocols containing bismuth compounds have been reported with variable success [4][5][6][7]. In a recent report of pooled data [8], bismuth triple therapies were found to be more efficacious than proton pump inhibitor triple therapies (77 vs. 64%) as a first-line treatment.…”

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Bismuth Salts in the Treatment of Helicobacter pylori Infection in Children

Gökçe

2009

Dig Dis Sci

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Delghani et al.[1] evaluated the efficacy of three different regimens for eradication of Helicobacter pylori (H. pylori) infection in children. The authors concluded that quadruple therapy containing bismuth yields better results and can be used as first-line of therapy. The study is both well designed and well managed, and highlights the need for novel therapies in children with H. pylori infection. Here are some important points of the study that should be discussed.The study group was composed of 120 children with a mean age of 12 ± 4 years (range 2-18 years). H. pylori eradication was assessed with urea breath test (UBT). The utility of UBT in children over 6 years of age was confirmed by numerous studies. The sensitivity and specificity for children in this group were found to be 100 and 98% respectively, with positive predictive value (PPV) and negative predictive values (NPV) of 98 and 100% respectively. In young children, however, false-positive results compromise the accuracy of the test. For children under the age of 6 years, specificity was determined to be 88% and PPV 69% [2]. The accuracy of UBT can be improved by increasing delta over baseline (DOB) cut-off values; however, the false-positive rate remains high [2,3]. It would be better to provide brief methodologic data regarding UBT including information at least about cut-off values and whether values are adjusted for age.The authors reported the eradication rate with quadruple therapy with bismuth 91.8% compared to 82.1 and 80.5% with current triple therapies containing clarithromycin in the second group and metronidazole in third group, respectively. The authors suggested quadruple therapy as the first-line of therapy for the eradication of H. pylori infection in children in their geographic area. Treatment of H. pylori infection in children with protocols containing bismuth compounds have been reported with variable success [4][5][6][7]. In a recent report of pooled data [8], bismuth triple therapies were found to be more efficacious than proton pump inhibitor triple therapies (77 vs. 64%) as a first-line treatment. Indeed, the eradication rate is better with quadruple therapy in the present study, but not sufficiently high to suggest it as a first-line therapy (p = 0.33). Secondly, bismuth compounds are major drugs of rescue regimens after H. pylori treatment failure. The most important cause of treatment failure is drug resistance. In this case, it is fairly logical to reserve bismuth compounds as a second-line option to decrease the risk of drug resistance.Although the use of bismuth compounds has been reported in children [8], they still require approval to use. Therefore, the use of bismuth compounds in children may be of ethical concern. In adults, it has recently been suggested that fluoroquinolone-based rescue therapies constitute an encouraging second-line strategy, representing an alternative to quadruple therapy with efficacy, simplicity, and safety [9][10][11]. Although pediatric data is limited, fluoroquinolone-based therapies can ...

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Evaluation of triple and quadruple Helicobacter pylori eradication therapies in Iranian children: a randomized clinical trial

Abstract: With regard to recent recommendations, we also suggest PPI, amoxicillin and clarithromycin triple therapy as a first-line eradication treatment, and quadruple therapies as a second-line option, in Iranian children.

Cited by 20 publications

References 21 publications

Efficacy of the Standard Quadruple Therapy Versus Triple Therapies Containing Proton Pump Inhibitor Plus Amoxicillin and Clarithromycin or Amoxicillin-Clavulanic Acid and Metronidazole for Helicobacter pylori Eradication in Children

Efficacy of the Standard Quadruple Therapy Versus Triple Therapies Containing Proton Pump Inhibitor Plus Amoxicillin and Clarithromycin or Amoxicillin-Clavulanic Acid and Metronidazole for Helicobacter pylori Eradication in Children

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

Bismuth Salts in the Treatment of Helicobacter pylori Infection in Children

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