Skip to main content
SpringerLink
Log in

Comparison of short- and long-term treatment protocols and the results of second-line quadruple therapy in children with Helicobacter pylori infection

  • Alimmentary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Research regarding the optimal therapeutic approach to Helicobacter pylori infection in children is ongoing. There is no consensus as to duration of treatment or second-line therapy. The purpose of this study was compare the efficacy of 7-day and 14-day triple therapies and report the results of second-line quadruple therapy in children.

Methods

A total of 275 consecutive H. pylori-infected patients were enrolled into two groups. Group 1 (n = 180) received triple therapy with 14 days of amoxicillin and clarithromycin and 21 days of proton pump inhibitor. Group 2 (n = 95) received triple therapy including 7 days of amoxicillin and clarithromycin with 21 days of proton pump inhibitor. Subsequently, 89 patients not responding to the triple therapies received quadruple therapy comprising omeprazole (14 days), bismuth subcitrate (7 days), doxycycline (7 days), and metronidazole (7 days). Eradication was evaluated by 13C-urea breath test.

Results

The per-protocol eradication rates in groups 1 and 2 were 60.5% and 55.8%, respectively (P = 0.44). In the second interview with 227 patients, severe symptoms were reported to have disappeared in 59% and decreased notably in 34.8%. Helicobacter pylori was eradicated in 66.7% of patients at the end of the quadruple therapy. In the third interview with 75 patients, severe symptoms had decreased in 38.6% and disappeared in 56%.

Conclusions

The different duration of the two treatment regimens had no impact on eradication rates. Furthermore, quadruple therapy was necessary to achieve H. pylori eradication after triple therapy. However, the eradication rate with quadruple therapy was still insuf-ficient. Consequently, a new therapeutic approach to H. pylori infection in children is needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ables AZ, Simon I, Melton ER. Update on Helicobacter pylori treatment. Am Fam Physician 2007;75:351–358.

    PubMed  Google Scholar 

  2. Di Mario F, Cavallaro LG, Scarpignato C. ’Rescue’ therapies for the management of Helicobacter pylori infection. Dig Dis2006;24:113–130.

    Article  PubMed  Google Scholar 

  3. Cavallaro LG, Egan B, O’Morain C, Di Mario F. Treatment of Helicobacter pylori infection. Helicobacter 2006;11:36–39.

    Article  PubMed  Google Scholar 

  4. Bourke B, Ceponis P, Chiba N, Czinn S, Ferraro R, Fischbach L, et al. Canadian Helicobacter Study Group Consensus Conference: update on the approach to Helicobacter pylori infection in children and adolescents—an evidence-based evaluation. Can J Gastroenterol 2005;19:399–408.

    PubMed  Google Scholar 

  5. Chelimsky G, Blanchard SS, Czinn SJ. Helicobacter pylori in children and adolescents. Adolesc Med 2004;15:53–56.

    Article  Google Scholar 

  6. Oderda G, Shcherbakov P, Bontems P, Urruzuna P, Romano C, Gottrand F, et al. Results from the pediatric European register for treatment of Helicobacter pylori (PERTH). Helicobacter 2007;12:150–156.

    Article  PubMed  Google Scholar 

  7. Paoluzi P, Iacopini F, Crispino P, Nardi F, Bella A, Rivera M, et al. 2-week triple therapy for Helicobacter pylori infection is better than 1-week in clinical practice: a large prospective single-center randomized study. Helicobacter 2006;11:562–568.

    Article  PubMed  Google Scholar 

  8. Zagari RM, Bianchi-Porro G, Fiocca R, Gasbarrini G, Roda E, Bazzoli F. Comparison of 1 and 2 weeks of omeprazole, amoxicillin and clarithromycin treatment for Helicobacter pylori eradication: the HYPER Study. Gut 2007;56:475–479.

    Article  PubMed  CAS  Google Scholar 

  9. Malfertheiner P, Megraud F, O’Morain C, Bazzoli F, El-Omar E, Graham D, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 2007;56:772–781.

    Article  PubMed  CAS  Google Scholar 

  10. Rodgers C, van Zanten SV. A meta-analysis of the success rate of Helicobacter pylori therapy in Canada. Can J Gastroenterol 2007;21:295–300.

    PubMed  Google Scholar 

  11. Magaret N, Burm M, Faigel D, Kelly C, Peterson W, Fennerty MB. A randomized trial of lansoprazole, amoxycillin, and clarithromycin versus lansoprazole, bismuth, metronidazole and tetracycline in the retreatment of patients failing initial Helicobacter pylori therapy. Dig Dis 2001;19:174–178.

    Article  PubMed  CAS  Google Scholar 

  12. Dixon MF, Genta RM, Yardley JH, Correa P. The exclusion criteria were as follows classification and grading of gastritis. The updated Sydney system. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 1996;20:1161–1181.

    Article  PubMed  CAS  Google Scholar 

  13. Gold BD, Colletti RB, Abbott M, Czinn SJ, Elitsur Y, Hassall E, et al. Helicobacter pylori infection in children: recommendations for diagnosis and treatment. J Pediatr Gastroenterol Nutr 2000;31:4907.

    Google Scholar 

  14. Wolle K, Malfertheiner P. Treatment of Helicobacter pylori. Best Pract Res Clin Gastroenterol 2007;21:315–324

    Article  PubMed  CAS  Google Scholar 

  15. Calvet X, Garcia N, Lopez T, Gisbert JP, Gene E, Roque M. A meta-analysis of short versus long therapy with a proton pump inhibitor, clarithromycin and either metronidazole or amoxycillin for treating Helicobacter pylori infection. Aliment Pharmacol Ther 2000;14:603–609.

    Article  PubMed  CAS  Google Scholar 

  16. Bytzer P, O’Morain C. Treatment of Helicobacter pylori. Helicobacter 2005;10:40–46.

    Article  PubMed  CAS  Google Scholar 

  17. Maconi G, Parente F, Russo A, Vago L, Imbesi V, Bianchi Porro G. Do some patients with Helicobacter pylori infection benefit from an extension to 2 weeks of a proton pump inhibitor-based triple eradication therapy? Am J Gastroenterol 2001;96:359–366.

    PubMed  CAS  Google Scholar 

  18. Moayyedi P, Langworthy H, Shanahan K, Tompkins DS, Dixon MF, Chalmers DM, et al. Comparison of one or two weeks of lansoprazole, amoxicillin, and clarithromycin in the treatment of Helicobacter pylori. Helicobacter 1996;1:71–74.

    Article  PubMed  CAS  Google Scholar 

  19. Oderda G, Rapa A, Bona G. A systematic review of Helicobacter pylori eradication treatment schedules in children. Aliment Pharmacol Ther 2000;14:1–8.

    Article  Google Scholar 

  20. Lam SK, Talley NJ. Report of the 1997 Asia Pacific Consensus Conference on the management of Helicobacter pylori infection. J Gastroenterol Hepatol 1998;13:1–12.

    Article  PubMed  CAS  Google Scholar 

  21. Akyon Y, Tuncer S, Demir H, Misirlioglu M, Usta Y. Detection of Helicobacter pylori and clarithromycin resistance by real-time PCR in children. 16th European Congress of Clinical Microbiology and Infectious Diseases. April 1–4, 2006, Nice, France. Abstract P 1449.

  22. Murakami K, Okimoto T, Kodama M, Sato R, Miyajima H, Ono M, et al. Comparison of amoxicillin-metronidazole plus famotidine or lansoprazole for amoxicillin-clarithromycin-proton pump inhibitor treatment failures for Helicobacter pylori infection. Helicobacter 2006;11:436–440.

    Article  PubMed  CAS  Google Scholar 

  23. Qasim A, O’Morain CA. Review article: treatment of Helicobacter pylori infection and factors influencing eradication. Aliment Pharmacol Ther 2002;16:24–30.

    Article  PubMed  CAS  Google Scholar 

  24. Khurana R, Fischbach L, Chiba NC, Veldhuyzen van Zanten S. An update on anti-Helicobacter pylori treatment in children. Can J Gastroenterol 2005;19:441–445.

    PubMed  Google Scholar 

  25. Gisbert JP, Pajares JM. Review article: Helicobacter pylori “rescue” regimen when proton pump inhibitor based triple therapies fail. Aliment Pharmacol Ther 2002;16:1047–1057.

    Article  PubMed  CAS  Google Scholar 

  26. Cammarota G, Martino A, Pirozzi G, Cianci R, Branca G, Nista EC, et al. High efficacy of 1-week doxycycline-and amoxicillinbased quadruple regimen in a culture-guided, third-line treatment approach for Helicobacter pylori infection. Aliment Pharmacol Ther 2004;19:789–795.

    Article  PubMed  CAS  Google Scholar 

  27. Fischbach LA, Van Zanten SV, Dickason J. Meta-analysis: the efficacy, adverse events, and adherence related to first-line anti-Helicobacter pylori quadruple therapies. Aliment Pharmacol Ther 2004;20:1071–1082.

    Article  PubMed  CAS  Google Scholar 

  28. Gene E, Calvet X, Azagra R, Gisbert JP. Triple vs. quadruple therapy for treating Helicobacter pylori infection: a meta-analysis. Aliment Pharmacol Ther 2003;17:1137–1143.

    Article  PubMed  CAS  Google Scholar 

  29. Dore MP, Maragkoudakis E, Pironti A, Tadeu V, Tedde R, Realdi G, et al. Twice-a-day quadruple therapy for eradication of Helicobacter pylori in the elderly. Helicobacter 2006;11:52–55.

    Article  PubMed  CAS  Google Scholar 

  30. Ozcay F, Kocak N, Temizel IN, Demir H, Ozen H, Yuce A, et al. Helicobacter pylori infection in Turkish children: comparison of diagnostic tests, evaluation of eradication rate, and changes in symptoms after eradication. Helicobacter 2004;9:242–248.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, School of Medicine, Hacettepe University, Sihhiye, 06100, Ankara, Turkey

    Yusuf Usta, Inci Nur Saltik-Temizel, Hulya Demir, Nuray Uslu, Hasan Ozen, Figen Gurakan & Aysel Yuce

Authors
  1. Yusuf Usta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Inci Nur Saltik-Temizel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hulya Demir
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nuray Uslu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hasan Ozen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Figen Gurakan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Aysel Yuce
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Usta, Y., Saltik-Temizel, I.N., Demir, H. et al. Comparison of short- and long-term treatment protocols and the results of second-line quadruple therapy in children with Helicobacter pylori infection. J Gastroenterol 43, 429–433 (2008). https://doi.org/10.1007/s00535-008-2187-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00535-008-2187-4

Key words

Search

Navigation