Eradication In Children Research Articles

Correlation of iron deficiency indexes with Eradication and Recurrence of Helicobacter Pylori Infection in Children.

To explore the correlation of iron deficiency (ID) indexes with eradication and recurrence of Helicobacter pylori (Hp) infection in children. This is a clinical comparative study. One hundred and twenty-six children who were first diagnosed as Hp infection in Baoding Children's Hospital (Hp infection group); and the control group included 200 children without Helicobacter Pylori infection (negative stool Hp antigen test and/or 13C-urea breath test) in local region at the same time from January 2020 to January 2022. Enrolled children were subjected to routine blood test, serum ferritin (SF), serum iron (SI) and total iron binding capacity (TIBC) detection. Meanwhile, children with Hp infection were given triple therapy for eradication and followed up for one year. The levels of SI, SF and Hb in non-eradication group were lower than those in eradication group (P<0.05); while TIBC level in the former group was higher than that in the latter group (P<0.05). Furthermore, SF level in the recurrence group was lower than that in the non-recurrence group (P<0.05). While there was no significant difference in Hb, SI and TIBC levels between the recurrence group and the non-recurrence group (P>0.05). Low level of SF may be a risk factor for difficulty in eradication and recurrence after eradication in children with Hp infection. Meanwhile, low levels of Hb and SI are influential factors for difficulty in eradication in children with Hp infection.

The effect of Saccharomyces boulardii supplementation on Helicobacter pylori eradication in children: a systematic review and meta-analysis of Randomized controlled trials

BackgroundIt is unclear whether Saccharomyces boulardii (S. boulardii) supplementation in standard triple therapy (STT) is effective in eradicating Helicobacter pylori (H. pylori) infection in children. We therefore conducted a meta-analysis of randomized controlled trials (RCTs) to assess the effect of S. boulardii supplementation on H. pylori eradication in children.MethodsWe conducted electronic searches in PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure and Wanfang database from the beginning up to September 2023. A random-effects model was employed to calculate the pooled relative risk (RR) with 95% confidence intervals (CI) through a meta-analysis.ResultsFifteen RCTs (involving 2156 patients) were included in our meta-analysis. Results of the meta-analysis indicated that S. boulardii in combination with STT was more effective than STT alone (intention-to-treat analysis : 87.7% vs. 75.9%, RR = 1.14, 95% CI: 1.10–1.19, P < 0.00001; per-protocol analysis : 88.5% vs. 76.3%, RR = 1.15, 95% CI: 1.10–1.19, P < 0.00001). The S. boulardii supplementation group had a significantly lower incidence of total adverse events (n = 6 RCTs, 9.2% vs. 29.2%, RR = 0.32, 95% CI: 0.21–0.48, P < 0.00001), diarrhea (n = 13 RCTs, 14.7% vs. 32.4%, RR = 0.46, 95% CI: 0.37–0.56, P < 0.00001), and nausea (n = 11 RCTs, 12.7% vs. 21.3%, RR = 0.53, 95% CI: 0.40–0.72, P < 0.0001) than STT group alone. Similar results were also observed in the incidence of vomiting, constipation, abdominal pain, abdominal distention, epigastric discomfort, poor appetite and stomatitis.ConclusionsCurrent evidence indicated that S. boulardii supplementing with STT could improve the eradication rate of H. pylori, and concurrently decrease the incidence of total adverse events and gastrointestinal adverse events in children.

ALPINE2: Efficacy and safety of 14-day vs 28-day inhaled aztreonam for Pa eradication in children with cystic fibrosis

BackgroundAntibiotic eradication therapies recommended for newly isolated Pseudomonas aeruginosa (Pa) in people with cystic fibrosis (pwCF) can be burdensome. ALPINE2 compared the efficacy and safety of a shortened 14-day course of aztreonam for inhalation solution (AZLI) with 28-day AZLI in paediatric pwCF. MethodsALPINE2 (a double-blind, phase 3b study) included children aged 3 months to <18 years with CF and new-onset Pa infection. Participants were randomized to receive 75 mg AZLI three times daily for either 28 or 14 days followed by 14 days' matched placebo. The primary endpoint was rate of primary Pa eradication (no Pa detected during the 4 weeks post AZLI treatment). Non-inferiority was achieved if the lower 95% CI bound of the treatment difference between the two arms was above −20%. Secondary endpoints included assessments of Pa recurrence during 108 weeks of follow-up after primary eradication. Safety endpoints included treatment-emergent adverse events (TEAEs). ResultsIn total, 149 participants were randomized (14-day AZLI, n = 74; 28-day AZLI, n = 75) and 142 (95.3%) completed treatment. Median age: 6.0 years (range: 0.3–17.0). Baseline characteristics were similar between treatment arms. Primary Pa eradication rates: 14-day AZLI, 55.9%; 28-day AZLI, 63.4%; treatment difference (CI), −8.0% (−24.6, 8.6%). Pa recurrence rates at follow-up end: 14-day AZLI, 54.1% (n = 20/37); 28-day AZLI, 41.9% (n = 18/43). TEAEs were similar between treatment arms. No new safety signals were observed. ConclusionsNon-inferiority of 14-day AZLI versus 28-day AZLI was not demonstrated. Both courses were well tolerated, further supporting AZLI short-term safety in paediatric and adolescent pwCF. ClinicalTrials.govNCT03219164

Primary Antibiotic Resistance And Effectiveness Of Clarithromycin Vs Metronidazole Based Therapy For Helicobacter Pylori Infection In Children.

NASPGHAN guidelines recommend regional antibiotic susceptibility profiling for H. pylori eradication treatment. Profiling local antibiotic resistance patterns is mandatory for successful H. pylori eradication in children. The aim of our study was to determine primary resistance to Clarithromycin and Metronidazole, most commonly used in the eradication regimens in children presenting with symptomatic H. pylori infection. This study was conducted at Children Hospital PIMS Islamabad from June 2020 to August 2021. The children of either gender age 2-14 years having symptomatic H. pylori infection (hematemesis, chronic abdominal pain) underwent stool for H. pylori Antigen. Children requiring urgent diagnostic endoscopy underwent rapid urease tests. Biopsies were taken from children having positive stool H. pylori Ag and rapid urease test for histological examination. The biopsy specimens were cultured and subsequently tested for antibiotic sensitivity. Out of 54 children having H. pylori infection 40/54 (74.074%) children had strains susceptible to antimicrobials and 14/54 (25.92%) were having resistance to antimicrobials. According to the pattern of antimicrobial sensitivity, they were further grouped into three (a) Clarithromycin and Metronidazole sensitive group (18/40, 45%) (b) Clarithromycin sensitive and Metronidazole resistant group (12/40, 30%) (c) Metronidazole sensitive group (10/40 25%). Clarithromycin and Metronidazole cannot be used as1stline treatment for H. pylori eradication in children and can only be used with known antimicrobial susceptibility.

Therapeutic eradication choices in Helicobacter pylori infection in children.

Current recommendations on Helicobacter pylori (H. pylori) eradication in children differ from adults. In H. pylori-infected adults, the eradication is always recommended because of the risk to develop gastrointestinal and non-gastrointestinal associated diseases. Instead, before treating infected children, we should consider all the possible causes and not merely focus on H. pylori infection. Indeed, pediatric international guidelines do not recommend the test and treat strategy in children. Therefore, gastroscopy with antimicrobial susceptibility testing by culture on gastric biopsies should be performed before starting the eradication therapy in children to better evaluate all the possible causes of the symptomatology and to increase the eradication rate. Whether antibiotic susceptibility testing is not available, gastroscopy is anyway recommended to better set any possible cause of symptoms and not simply focus on the presence of H. pylori. In children the lower antibiotics availability compared to adults forces to treat based on antimicrobial susceptibility testing to minimize the unsuccessful rates. The main antibiotics used in children are amoxicillin, clarithromycin, and metronidazole in various combinations. In empirical treatment, triple therapy for 14 days based either on local antimicrobial susceptibility or on personal antibiotic history is generally recommended. Triple therapy with high dose of amoxicillin is a valid alternative choice, either in double resistance or in second-line treatment. Moving from therapeutic regimens used in adults, we could also select quadruple therapy with or without bismuth salts. However, all the treatment regimens often entail unpleasant side effects and lower compliance in children. In this review, the alternative and not yet commonly used therapeutic choices in children were also analyzed.

245 Safety of inhaled tobramycin for Pseudomonas aeruginosa eradication in children with cystic fibrosis younger than 1

245 Safety of inhaled tobramycin for Pseudomonas aeruginosa eradication in children with cystic fibrosis younger than 1

244 Impact of the timing of reculture after inhaled tobramycin for Pseudomonas aeruginosa eradication in children with cystic fibrosis

244 Impact of the timing of reculture after inhaled tobramycin for Pseudomonas aeruginosa eradication in children with cystic fibrosis

Оптимізація ерадикаційного лікування хронічного гастродуоденіту, асоційованого з Helicobacter pylori, у дітей із використанням спорового рекомбінантного пробіотика на основі B.subtilis

Актуальність. Helicobacter pylori (Нр) значно поширена в дітей в Україні. Хронічний гастродуоденіт є основною нозологією в дітей, асоційованою з Нр, що потребує комплексного, перш за все ерадикаційного, лікування. Для оптимізації ефективного використання ерадикаційних схем сучасні міжнародні рекомендації передбачають можливість використання пробіотиків. Мета: оцінити вплив пробіотика Субалін на ерадикаційну ефективність та переносимість схем антихелікобактерної терапії в дітей 12–18 років із Нр-позитивним хронічним гастродуоденітом. Матеріали та методи. Під спостереженням перебували 50 дітей із Hp-асоційованими хронічними гастродуоденітами віком від 12 до 18 років. Пацієнтів розподілено на 2 групи залежно від призначення пробіотика. Діагноз верифікували з використанням фіброгастроскопії, ендоскопічної рН-метрії, визначення Нp-інфекції. Результати фіксували в розроблену індивідуальну карту пацієнта й статистично обробляли. Результати. Результати використання пробіотика Субалін у пацієнтів основної групи одночасно із застосуванням стандартних педіатричних схем ерадикації Hp першої лінії при лікуванні дітей і підлітків із Нр-позитивними формами хронічного гастродуоденіту свідчать про доцільність, ефективність і перспективність такого лікування. Підтвердженням цього є позитивна динаміка скарг, відсутність побічних ефектів (у тому числі антибіотик-асоційованої діареї) і добра переносимість препаратів у схемах потрійної чи квадротерапії на фоні прийому спорового рекомбінантного пробіотика в переважної більшості пацієнтів. Пацієнти з групи порівняння теж мали позитивну динаміку основних скарг, але менш виражену. Натомість погіршення переносимості й побічні дії стандартних ерадикаційних схем зустрічалися в них вірогідно частіше (у середньому на 35–40 %) порівняно з пацієнтами основної групи. Крім того, призначення Субаліну збільшує ерадикаційну ефективність стандартних анти-Нр схем першої лінії на 5 %. Висновки. Використання спорового рекомбінантного пробіотика Субалін одночасно зі стандартними ерадикаційними схемами в дітей із 12 років є доцільним, тому що дозволяє підвищити ерадикаційну ефективність на 5 % і покращити переносимість анти-Hp препаратів і, відповідно, прихильність пацієнтів до дотримання лікування й рекомендацій. Застосування Bacillus subtilis уже на першому етапі лікування допомагає оптимізувати терапевтичні заходи щодо дітей старшого віку з Нр-позитивними варіантами хронічного гастродуоденіту.

Effect of Helicobacter pylori eradication therapy on clinical and laboratory biomarkers associated with gastric damage in healthy school-aged children: A randomized non-blinded trial.

Helicobacter pylori (H.pylori) is the primary cause of gastric cancer and eradication in healthy adults has proven effective in decreasing cancer incidence. H.pylori is acquired largely in early childhood, however, the benefits of eradication in children are controversial. We aimed to determine the effect of H.pylori eradication on clinical and laboratory markers associated with gastric damage in apparently healthy school-aged children. This was a pilot non-blinded trial including 61 children persistently infected with H.pylori who were randomized to eradication/no treatment and followed for at least 12months, evaluating clinical and blood markers (Pepsinogen I (PGI) and II (PGII) determined by ELISA) associated with gastric damage. The treatment consisted of a sequential scheme including 7days of omeprazole+amoxicillin followed by 7days of omeprazole+clarithromycin+metronidazole; adherence and tolerance were surveyed. Eradication rates were assessed by stool antigen detection or urea breath test 1month following treatment every 4months thereafter to detect reinfection. Eradication occurred in 30/31 treated children (median age: 8.8, range: 7.9-10.8) and in 0/30 non-treated controls (median age: 8.6, range: 7.9-11) (p<.001). Treatment was associated with mild transient symptoms (altered taste, nocturnal upper abdominal pain, nausea, and diarrhea). Baseline frequency of symptoms was low and eradication did not change symptoms compared to controls. PGI, PGII, and anti-H.pylori seropositivity were similar in both groups at baseline and significantly decreased only in eradicated patients; PGI (92.5 vs. 74.4, p<.001), PGII (15.2 vs. 8.9, p<.001) levels, and frequency of anti-H.pylori seropositivity (100 vs. 68%, p<.001) respectively. Four eradicated children (13%) were reinfected during follow-up. H.pylori eradication therapy in apparently asymptomatic school-aged children was well tolerated and associated with decreased serum PGI and PGII levels. Future studies should expand on the middle-long-term effect of early H.pylori eradication, especially on preventing gastric cancer.

Comparison of the Different Protocols for the Eradication of Pediatric Helicobacter Pylori Infection in Iran

Background Helicobacter pylori has become very important recently due to infecting around 50% of the population worldwide. This infection can cause peptic ulcer disease and gastric cancer. This study aimed to evaluate the efficacy of common triple treatment, sequential treatment, and other regimens for Helicobacter pylori eradication in children. Materials and Methods: In this retrospective cohort study, 40 children who were diagnosed with Helicobacter pylori infection by endoscopic and pathologic features in the Children’s Medical Center of Tehran, Iran, in 2018 were included. The questionnaire was completed by telephone interview. Types of protocols include triple therapy (proton pump inhibitors with clarithromycin and amoxicillin or metronidazole for 2 weeks), sequential therapy (proton pump inhibitors with amoxicillin for 5 days followed by proton pump inhibitors with clarithromycin and metronidazole for 5 days), and other treatments (every protocol except triple and sequential regimens). At the end, we compared the efficacy of the different protocols for eradicating this infection by urea breath test or stool antigen test 8 weeks after therapy. Results: The age of patients with and without successful eradication was 8.12 and 7.8 years, respectively (p=0.8). There was no significant difference between both sexes (p=0.999) in the frequencies of eradication. The eradication rate of Helicobacter pylori was 95.5% in sequential therapy, 100% in conventional triple therapy, and 87.5%in other regimens. There was no significant difference between different protocols (p=0.422). Conclusion Determining first-line treatment for eradicating Helicobacter pylori infection is important to increase treatment success and reduce rate of secondary antimicrobial resistance. Our study showed that sequential treatment is as effective as conventional treatment in eradication of this infection in children.

Antibiotic Resistance of Helicobacter pylori Strains Isolated From Pediatric Patients in Southwest China.

The number of antibiotics that are appropriate for Helicobacter pylori eradication in children is limited. Profiling regional or population-specific antibiotic resistance is essential in guiding the H. pylori eradication treatment in children. The aim of this study was to evaluate the antibiotic resistance in H. pylori strains isolated from children and adolescents in Southwest China. Gastric biopsies from 157 pediatric patients with or without previous H. pylori eradication treatment were collected for H. pylori culture. Susceptibility to amoxicillin (AML), clarithromycin (CLR), metronidazole (MTZ), levofloxacin (LEV), tetracycline (TET), furazolidone (FZD), and rifampicin (RIF) was determined by E-test or a disk diffusion assay. A total of 87 patients from three ethnic groups (Han/Tibetan/Yi) were H. pylori culture positive (55.4%). The overall resistance rates were 55.2% for CLR, 71.3% for MTZ, 60.9% for RIF, and 18.4% for LEV. No isolate was found to be resistant to AML, TET, and FZD. Among the 53 treatment-naïve pediatric patients, primary resistance rates to clarithromycin, metronidazole, levofloxacin, and rifampicin were 45.3, 73.6, 15.1, and 60.4%, respectively. Among the 34 treatment-experienced patients, secondary resistance rates to clarithromycin, metronidazole, levofloxacin, and rifampicin were 70.6, 67.6, 23.5, and 61.8%, respectively. Isolates exhibiting simultaneous resistance to clarithromycin and metronidazole were 28.3 and 52.9% among the treatment-naïve and treatment-experienced patients, respectively. In conclusion, among pediatric patients in Southwest China, resistance rates were high for clarithromycin, metronidazole, levofloxacin, and rifampicin, whereas nil resistance was found to amoxicillin, tetracycline, and furazolidone. Our data suggest that the standard clarithromycin-based triple therapy should be abandoned as empiric therapy, whereas the bismuth quadruple therapy (bismuth/PPI/amoxicillin/tetracycline) would be suitable as first-line empiric treatment regimen for this pediatric population. Tetracycline and furazolidone may be considered for treating refractory H. pylori infections in adolescent patients.

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

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.

Risk factors for recurrence of Helicobacter pylori infection after successful eradication in Chinese children: A prospective, nested case‐control study

Limited research has been published on the recurrence of Helicobacter pylori infection and risk factors in Chinese children. Our study aimed to identify risk factors for Helicobacter pylori infection recurrence after successful eradication in children. A prospective, nested case-control study was performed. A cohort of 230 children with successful eradicationofHelicobacter pylori in Baoding (China) was selected from January 2018 to February 2019. A standardized questionnaire was used to obtain socioeconomic details. Eradication regimens and Helicobacter pylori antibiotic susceptibility testing results were also recorded. Interleukin-1β level, interferon-γ level, and genetic susceptibility (IFNGR1 and PTPRZ1 gene polymorphisms) were analyzed. All children were followed for 1year. Among 218 (94.8%) children who were successfully followed, 41 children (18.8%) had a Helicobacter pylori infection recurrence. The recurrence rate was higher in children ≤10years old than >10years old (22.8% vs 7.1%, P=.01). There was no significant difference between the recurrence group and the non-recurrence group in terms of types of therapy and antibiotic sensitivity (P>.05). Multivariable regression results indicated that residence in urban areas, higher household income, and having lunch at home were significantly protective against recurrence (OR 0.155, 0.408, and 0.351 respectively), whereas Helicobacter pylori infection in family members increased the risk of recurrence (OR 2.283). The levels of IL-1β and IFN-γ exhibited no significant difference between the recurrence group and the non-recurrence group. The allele frequency of G in the IFNGR1-56 site, A in the IFNGR1-600 site, and T in the IFNGR1-565 site was significantly higher in the recurrence group when compared to the non-recurrence group (P<.05). The Helicobacter pylori infection recurrence rate is high in children in Baoding region and is closely correlated to socioeconomic factors. The IFNGR1 gene polymorphism may be an independent risk factor for Helicobacter pylori infection recurrence.

Gastric microbiota and probiotics opportunities in helicobacter pylori eradication in children

Gastric microbiota and probiotics opportunities in helicobacter pylori eradication in children

Impact of Helicobacter pylori Eradication in Children with Acute Immune Thrombocytopenia: A Randomized Controlled Study

Background: At present, some evidence supports the role of Helicobacter pylori eradication in treating childhood immune thrombocytopenia (ITP). Objectives: This study was designed to investigate the association between H. pylori eradication and platelet count in children with acute ITP. Methods: Thirty children with a diagnosis of acute ITP and H. pylori infection were studied. This randomized and controlled study was done in Amir-Kabir Hospital, Arak, Iran. Patients were randomly allocated 1:1 to standard ITP and H. pylori treatments or standard ITP treatment. For 6 months, studied subjects had monthly follow-ups. Results: The mean ± standard deviation (SD) age was 11 years with a majority of females (67.9 % vs. 32.1 %). The mean platelet count was 16.93 ± 10.1 (109/L) in the ITP and H. pylori therapy group, and15.0 ± 3.8 (109/L) in the ITP therapy group at the baseline. After 1 week of treatment, mean platelet counts increased to 136.5 ± 55.20 and 124.0 ± 45.70 in the two groups, respectively (109/L). The differences between the two groups were not statistically significant at other time intervals. Children that received ITP and H. pylori therapies had a higher rate of gastrointestinal symptoms (P < 0.01). Conclusions: Our findings suggest that H. pylori eradication did not significantly affect the platelet count compared to standard ITP therapy in children with acute ITP.

The majority of MRSA colonized children not given eradication treatment are still colonized one year later. Systemic antibiotics improve the eradication rate

Background: Colonization with methicillin-resistant Staphylococcus aureus (MRSA) can cause endogenously derived infections and be a source of transmission to other people. Neither colonization time of asymptomatic MRSA colonization nor the effect of treatment aiming at MRSA eradication in children has been thoroughly investigated.Methods: Two hundred ninety-three children <18 years in the mandatory follow-up program for MRSA-carriers in Malmö, Sweden were evaluated. Samples from the throat, nares, perineum and skin lesions from each child were screened for MRSA with a PCR-based broth enrichment method. PVL presence and spa-type were evaluated in a majority of cases. The sampling was repeated approximately every 6 month after initial detection. When three consecutive sets of negative samples during at least a 6-month period were obtained, the MRSA was considered permanently eradicated. MRSA eradication treatment given, on clinical grounds during follow-up, was noted.Results: One year after detection 62% of the untreated children were still MRSA positive and after 2 years 28%. MRSA throat colonization and having MRSA positive household contacts significantly prolonged the observed colonization time. Topical MRSA eradication treatment was successful in 36% of cases and in 65% if systemic antibiotics were added. Presence of PVL correlated with shorter observed colonization time in the older age group and with increased eradication success among throat carriers.Conclusion: MRSA throat colonization and having MRSA positive household contacts prolongs the time of MRSA colonization in children. Systemic antibiotics enhance the effect of MRSA eradication treatment.

Comparison of combination of probiotic and standard therapy compared to standard therapy on eradication of Helicobacter pylori infection in children

Background Helicobacter pylori (H. pylori) infection is thought to be the etiology of chronic gastritis, peptic ulcer, and risk factor for gastric cancer. Management of H. pylori infection in children is associated with several problems such as compliance to therapy, untolerated side effects, and antibiotic resistance. Probiotic is reported to give beneficial effect in the management of H. pylori infection and there is no study yet on the effect of probiotic in eradication of H. pylori infection in Indonesian children.Objectives To study the effect of additional probiotic in the standard therapy on the rate of H. pylori infection eradication in children and its side effect.Methods This was a double blind randomized controlled trial performed in 23 children with H. pylori infection at Kampung Melayu and Rawa Bunga District. The diagnosis was determined based on Helicobacter pylori stool antigen test (HpSA). Subjects were randomly assigned to either receive receive amoxiycilin, clarithromycin, omeprazole, and probiotic (2 x 109 cfu of Lactobacillus acidophilus La5 and Bifidobacterium lactis Bb12) or amoxicillin, clarithromycin, omeprazole dan placebo (maltodextrin). HpSA examination was evaluated again after 2 weeks of therapy.Results Two of 13 subjects in the treatment group and 6 of 10 subjects in the control group experienced side effects. Eradication rate in the treatment group is higher than the control group (13/13 vs 7/10) but the correlation between additional probiotic with the eradication rate of H. pylori is not statistically significant.Conclusions Probiotic can reduce the incidence of side effects due to antibiotic used in H. pylori eradication (2/13 vs 6/10, p &lt; 0.012). [Paediatr Indones. 2010;50:38-41].

Helicobacter pylori Infection and Children's Growth: An Overview.

Helicobacter pylori infection is acquired in early childhood, yet its role in children's health is still not fully clear. In this narrative review, we focused on the association between H pylori infection and children's growth. A literature search of the Ovid MEDLINE (till June 2015) and EMBASE (till August 2015) databases was performed using the terms "Helicobacter pylori, growth, body height, growth disorders and child development." Original studies that addressed the association between H pylori infection or eradication and children's growth were reviewed and the risk of bias of each study was assessed. The existing evidence is based on observational studies (N = 48) and suggests that H pylori infection may adversely influence children's growth; findings were more consistent across studies with low risk of bias. Regarding linear growth, observational studies have repeatedly linked between H pylori infection and slower or diminished linear growth; yet, it is not known whether this association is causal. The association between H pylori infection and ponderal growth has been less consistent. Scarce evidence exists on the effect of H pylori eradication on children's skeletal growth and weight gain, but there is an indication that H pylori eradication may benefit nutritional status. H pylori infection may impair children's growth. Additional studies, especially clinical trials, are needed to elucidate the role of H pylori eradication in children's growth, and the mechanisms that may be involved in such.

Saccharomyces Boulardii in Helicobacter Pylori Eradication in Children: A Randomized Trial From Iran.

Background:Helicobacter pylori infects around 50% of the human population and is asymptomatic in 70% of the cases. H. pylori eradication in childhood will not only result in peptic symptoms relief, but will also prevent late-term complications such as cancer. Today, probiotics are being increasingly studied in the treatment of gastrointestinal infections as an alternative or complement to antibiotics.Objectives:In this study we aimed to assess the effect of S. boulardii supplementation on H. pylori eradication among children in our region.Patients and Methods:In this randomized double-blind placebo-controlled clinical trial 28 asymptomatic primary school children with a positive H. pylori stool antigen (HpSA) exam were randomly allocated into the study group, receiving Saccharomyces boulardii, and the control group receiving placebo capsules matched by shape and size, for one month. The children were followed up weekly and were reinvestigated four to eight weeks after accomplished treatment by HpSA testing. The significance level was set at P < 0.05.Results:24 children completed the study. The mean HpSA reduced from 0.40 ± 0.32 to 0.21 ± 0.27 in the study group, indicating a significant difference (P = 0.005). However, such difference was not observed in the control group (P = 0.89). Moreover, the HpSA titer showed a 0.019 ± 0.19 decrease in the study group whereas the same value was 0.0048 ± 0.12 for the controls, again stating a significant difference (P = 0.01).Conclusions:Saccharomyces boulardii has a positive effect on reducing the colonization of H. pylori in the human gastrointestinal system but is not capable of its eradication when used as single therapy.

Sequential Therapy is Superior to Triple Therapy for Helicobacter pylori Infection in Children: A Meta-Analysis.

To assess the efficacy and safety of 10-d sequential therapy compared to 5 to 14-d triple therapy for treating Helicobacter pylori infections in children according to the eradication rates. The Cochrane Library, MEDLINE, EMBASE, China National Knowledge Infrastructure databases, and other sources were searched in November 2014 without language restrictions. Randomized controlled trials (RCTs) that compared sequential therapy with triple therapy for H. pylori eradication in children were included. Dichotomous data were pooled to obtain the relative risk (RR) of the eradication rate with a 95% confidence interval (CI). Fourteen RCTs with 1698 participants (718 and 980 for sequential and triple therapy, respectively) were included. The intention-to-treat eradication rates were 73% (95% CI: 70-76) and 66% (95% CI: 64-70) for sequential and triple therapy, respectively. The pooled RR was 1.16 (95% CI: 1.09-1.23), resulting in a number needed to treat of 16 (95% CI: 10-48), favoring sequential therapy. Sequential therapy was superior to 7- and 10-d triple therapy. Sequential and triple therapy did not differ significantly in the overall risk of adverse effects. In children, sequential therapy appears to be superior to triple therapy for H. pylori eradication, although the eradication rates remain lower than the expected goal with both treatments. Factors-associated with a higher risk of eradication failure, such as compliance and antimicrobial resistance, remain insufficiently investigated. Therefore, further high-quality RCTs are needed to compare these different eradication treatment approaches.