Efficacy of a novel sequential treatment regimen containing bismuth for Helicobacter pylori eradication in Turkish children.

Abstract

Eradication rates of Helicobacter pylori (Hpylori) with standard triple therapy are gradually decreasing all over the world, including in children, due to the development of strains resistant to antimicrobials. Sequential therapy can be used as an alternative method to increase eradication rates. A total of 75 patients≥8years of age with Hpylori gastritis were included in the study. According to Rome IV criteria, 38 patients had functional abdominal pain and dyspepsia, and 37 patients had alarm findings suggesting organic disease. Patients were treated with a novel sequential therapy consisting of the proton pump inhibitor (PPI)-lansoprazole (1mg/kg/day, maximum 30mg daily), amoxicillin (50mg/kg/d in two doses, maximum 2×1000mg) for 7days followed by PPI-lansoprazole (1mg/kg/d, maximum 30mg daily), metronidazole (20mg/kg/day in two doses, maximum 2 x 500mg), tetracycline (50mg/kg/d divided into four equal doses, maximum 4 x 500mg), and bismuth subsalicylate (262mg QID in patients≤10years of age, 524mg QID in patients>10years of age in days 8-14). Eradication status was evaluated by Hpylori stool antigen test 8weeks after the completion of treatment. The mean age of the patients was 15.1±2.4years and 51 (68%) were female. No patient discontinued therapy due to side effects. All patients had antral gastritis (76.0%) or pangastritis (24.0%). The peptic ulcer rate was 6.6%. Eradication therapy was given to all patients with or without peptic ulcer. Hpylori eradication was achieved in 69 (92.0%) patients and symptoms improved in 61 of those eradicated. As a first-line treatment for Hpylori eradication in children, administering a novel sequential therapy including bismuth for 14days provides a high rate of eradication.