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Sequential eradication therapy promising for H. pylori in children
Albrecht P. J Pediatr. 2011; In press.
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Sequential eradication therapy was slightly better at eradicating Helicobacter pylori when compared with the standard of care, triple therapy, but the difference was not significant, according to a study published online.
A team of doctors from the University of Warsaw, Poland, led by Piotr Albrecht, MD, noted that although triple therapy with a proton pump inhibitor with clarithromycin and amoxicillin or metronidazole is the recommended treatment, this therapy has its drawbacks, including increasing antibiotic resistance as a result of using so many antibiotics.
The double-blinded study included 107 children aged 3 to 18 years who were seen at the university’s department of pediatric gastroenterology and nutrition between December 2006 and September 2009 for infectionH. pylori. Children were randomly assigned to either the experimental therapy or the standard triple therapy.
About 86.5% of the children who participated in the sequential group showed eradication of the H. pylori infection 8 weeks after treatment compared with 68.6% of those who were on the standard triple therapy. Neither group showed any difference in adverse effects due to treatment.
The researchers noted that another recently published meta-analysis that indicated that sequential therapy may be of benefit, particularly in instances where H. pylori demonstrate resistance to clarithromycin. The researchers concluded that although sequential therapy seems promising, more randomized trials are needed to validate the findings, particularly in pediatric populations, where data are limited.
Disclosure: The researchers reported no relevant financial disclosures.
Helicobacter pylori infection is a challenge to treat in adults and children. A major limitation in response to treatment is development of resistance by the infecting strains. This study suggested that a sequentially administered regimen of anti-H. pylori drugs may result in improved microbiologic response compared with standard therapy. Additional study in different populations will be needed to confirm these findings.
– Herbert DuPont, MD
St. Luke's Episcopal Hospital, Houston, Texas