Sequential therapy versus standard triple therapy for Helicobacter pylori
eradication in children: any advantage in clarithromycin-resistant strains?
Author(s): Kutluk G(1), Tutar E, Bayrak A, Volkan B, Akyon Y, Celikel C, Ertem D.
Affiliation(s): Author information:
(1)aDivision of Pediatric Gastroenterology, Hepatology and Nutrition bDepartment
of Pathology, Marmara University School of Medicine, Istanbul cDepartment of
Microbiology, Hacettepe University School of Medicine, Ankara, Turkey.
Publication date & source: 2014, Eur J Gastroenterol Hepatol. , 26(11):1202-8
OBJECTIVE: There has been a marked decrease in the eradication rates of
Helicobacter pylori infection with standard triple therapy worldwide. Hence,
sequential therapy has gained attention as a promising treatment during the last
few years. This study was carried out to compare the efficacy of sequential
versus standard triple therapy in the context of clarithromycin (CLA) resistance.
MATERIALS AND METHODS: In this study, children between 3 and 18 years of age, who
had documented H. pylori infection, were randomized to receive either standard
triple or sequential therapy. H. pylori eradication was ascertained using the
C-urea breath test 4-6 weeks after the completion of the treatment. Real-time PCR
was performed on gastric biopsy samples for assessment of CLA resistance.
RESULTS: In all, 148 children (median age: 12.18±3.51 years) were recruited
randomly into the study. The intention-to-treat eradication rates were 50%
(37/74) for the sequential treatment group and 52.7% (39/74) for the standard
triple treatment group (P=0.87). A total of 136 children completed the study. The
per-protocol eradication rates were 56% (37/66) and 55.7% (39/70) for sequential
and standard triple therapy groups, respectively. CLA resistance was assessed and
113 children were included in the final analysis. Of 113 participants, 53 were in
the sequential treatment group and 60 were in the standard triple treatment
group. The success rates of the respective therapies (29/53=54.7% in sequential,
33/60=55% in standard therapy) were similar (P=0.98). CLA resistance was detected
in 29 (25.7%) of the patients. Eradication rates with sequential therapy in CLA
susceptible and resistant cases were 60.5% (23/38) and 40% (6/15), respectively
(P=0.23). The corresponding figures for the standard triple treatment group were
63% (29/46) and 28.6% (4/14) (P=0.033). Although a higher eradication rate was
observed in CLA-resistant cases with sequential therapy, the difference did not
reach statistical significance (P=0.69).
CONCLUSION: In this study, standard triple treatment failed to eradicate H.
pylori infection in the majority of the children, and sequential therapy offered
only a small advantage over standard triple therapy in the eradication of
CLA-resistant strains.
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