Omeprazole‐induced Myositis in a Child Receiving Triple Therapy for Helicobacter pylori Infection

Abstract

How Often Do You Fail to Take All of Your Medication?T o the Editor: We read with interest the article by Prieto-Jimenez et al (1); however, the conclusion overlooks the problem of adherence to treatment. A success rate of 44% has never been reported since dual therapies were introduced or in more recent pediatric trials. Compliance is the most important factor predicting treatment success (2), and eradication rates of 20% were reported in those taking <60% of pills (3).In the El Paso children, several indicators of poor adherence are present: treatment of asymptomatic disease, side effects/ bad taste of medication, patient's lack of belief in the benefits of treatment and of insight into the illness, complexity of treatment and possibility of receiving placebo, patients not asking for medical advice, and low income (4).That compliance was suboptimal is confirmed by a second article on the same cohort aiming at assessing iron stores after Helicobacter pylori treatment (5). How do the authors explain that after 6 months of iron administration, ferritin levels only showed a minimal increase after H pylori eradication? A similar experience revealed that in 2 months, children who received iron plus eradication doubled their ferritin content. ( 6) Perhaps, as in the case of antibiotics, they were poorly adherent to iron therapy. We have employed the sequential regimen to treat >200 children with an eradication rate >85% (7). Our data have been confirmed by a recent meta-analysis (eradication rate of 90.7%; 95% confidence interval 83.8%-94.9%) (8).Adherence is a primary determinant of treatment efficacy. When treatment outcome is markedly lower than expected, the key to the reading may well be the question ''how often do you fail to take all your medication?''

Proton Pump Inhibitors

“…Visruthan et al 13 reported a case of a 12-year-old Chinese male patient who was started on a 14-day course of triple therapy for eradication of Helicobacter pylori . Treatment included omeprazole 20 mg twice daily, amoxicillin 500 mg twice daily, and clarithromycin 500 mg twice daily.…”

“…The authors conclude that PPIs should be recognized as having the potential for this rare adverse effect, especially in children reciving triple therapy with concomitant use of clarithromycin. 13…”

“…Additionally, the author concluded that omeprazole therapy may cause subtle biochemical changes at the subcellular level because no major side effects were seen in prior short-term studies. 12 Visruthan et al 13 reported a case of a 12-year-old Chinese male patient who was started on a 14-day course of triple therapy for eradication of Helicobacter pylori. Treatment included omeprazole 20 mg twice daily, amoxicillin 500 mg twice daily, and clarithromycin 500 mg twice daily.…”

All-trans retinoic acid-induced myositis during treatment of acute promyelocytic leukemia

“…The drugs that the patient had been exposed to before the onset of myositis were reviewed and myositis might also be related to daptomycin, omeprazole or allopurinol. [6][7][8] While their participation cannot be definitively excluded, the three of them usually present with elevated CK levels, with or without muscle symptoms while our patient presented with serum CK within normal range despite muscle pain and swelling. In addition, our patient had previously been exposed to omeprazole without having observed any side effects.…”

Translational High‐Dimensional Drug Interaction Discovery and Validation Using Health Record Databases and Pharmacokinetics Models

“…From this evidences omeprazole is the primary candidate that induced myopathy. In addition, there were 16 case reports in the literature and summarized in a case series that associate the use of omeprazole with myopathy . Among these 16 cases, two were identified as Asians, but race was not reported among the other cases.…”