Management of Helicobacter pylori infection in paediatric patients in Europe: results from the EuroPedHp Registry

Abstract

Purpose The EuroPedHp-registry aims to monitor guideline-conform management, antibiotic resistance, and eradication success of 2-week triple therapy tailored to antibiotic susceptibility (TTT) in Helicobacter pylori-infected children. Methods From 2017 to 2020, 30 centres from 17 European countries reported anonymized demographic, clinical, antibiotic susceptibility, treatment, and follow-up data. Multivariable logistic regression identified factors associated with treatment failure. Results Of 1605 patients, 873 had follow-up data (53.2% female, median age 13.0 years, 7.5% with ulcer), thereof 741 (85%) treatment naïve (group A) and 132 (15%) after failed therapy (group B). Resistance to metronidazole was present in 21% (A: 17.7%, B: 40.2%), clarithromycin in 28.8% (A: 25%, B: 51.4%), and both in 7.1% (A: 3.8%, B: 26.5%). The majority received 2-week tailored triple therapy combining proton pump inhibitor (PPI), amoxicillin with clarithromycin (PAC) or metronidazole (PAM). Dosing was lower than recommended for PPI (A: 49%, B: 41%) and amoxicillin (A: 6%, B: 56%). In treatment naïve patients, eradication reached 90% (n = 503, 95% CI 87–93%) and 93% in compliant children (n = 447, 95% CI 90–95%). Tailored triple therapy cured 59% patients after failed therapy (n = 69, 95% CI 48–71%). Treatment failure was associated with PAM in single clarithromycin resistance (OR = 2.47, 95% CI 1.10–5.53), with PAC in single metronidazole resistance (OR = 3.44, 95% CI 1.47–8.08), and with low compliance (OR = 5.89, 95% CI 2.49–13.95). Conclusions Guideline-conform 2-weeks therapy with PPI, amoxicillin, clarithromycin or metronidazole tailored to antibiotic susceptibility achieves primary eradication of ≥ 90%. Higher failure rates in single-resistant strains despite tailored treatment indicate missed resistance by sampling error.

Antibiotic resistance, heteroresistance, and eradication success ofHelicobacter pyloriinfection in children

“…Our results regarding the efficacy of first line and second-line treatments agree with the results of the EuroPedHp registry that analyzed data from 17 European pediatric hospitals from 2017 to 2020 and was published recently by Le Thi et al 3 This European…”

“…Our results regarding the efficacy of first line and second‐line treatments agree with the results of the EuroPedHp registry that analyzed data from 17 European pediatric hospitals from 2017 to 2020 and was published recently by Le Thi et al 3 This European Registry study also showed that resistant strains are more difficult to eradicate even if the treatment is tailored to antimicrobial susceptibility. They suggested that this was due to undetected heteroresistance.…”

“…From 2013 to 2016, data from 181 patients were submitted to the EuroPedHP‐Registry 17 . From 2017 to 2019 data from 110 patients were submitted to the EuroPedHP‐Registry 3 …”

“…Failure of eradication treatment is mainly correlated with antimicrobial resistance and low patient adherence to the treatment regimen. [3][4][5] It is known that CLA resistance is caused by point mutations in 23S rRNA gene, mainly through mutations at A2143G, A2142G, and A2142C positions. 6 MET resistance can be due to genetic rearrangements in the rdxA and point mutations in the frxA and frxB genes, 7,8 but the molecular mechanism is not fully understood.…”

“…Failure of eradication treatment is mainly correlated with antimicrobial resistance and low patient adherence to the treatment regimen 3–5 . It is known that CLA resistance is caused by point mutations in 23S rRNA gene, mainly through mutations at A2143G, A2142G, and A2142C positions 6 .…”