Therapeutic Efficacy of Dual Therapy and Triple Therapy for Helicobacter pylori Infection in Children

Bae, Sun Hwan; Koh, Jae Sung; Seo, Jeong Kee

Abstract

PURPOSE
An optimal treatment for Helicobacter pylori (H. pylori) infection in children has not yet been established. In this study, the efficacy and the tolerability of triple therapy with colloidal bismuth subcitrate (CBS), amoxicillin and metronidazole, were evaluated in comparison with dual therapy with CBS and amoxicllin.
METHODS
Eighty-six children with H. pylori infection, aged 6 years to 14 years, were enrolled in this study. H. pylori infection was confirmed by endoscopic antral biopsy with an rapid urease test, culture and a modified Giemsa stain. The children were considered positive for H. pylori infection if culture was positive or if both modified Giemsa staining and CLO test were positive. The children were treated with one of the following three regimens. Dual therapy with CBS for 4 weeks and amoxicillin for 2 weeks (Group I. n=57: 1993.8-1995.1), Triple therapy with CBS for 4 weeks, amoxcillin for 2 weeks and metronidazole for 2 weeks (Group IIa. n=11: 1995.2-1995.7), and Triple therapy with CBS for 2 weeks, amoxicillin for 2 weeks and metronidazole for 2 weeks (Group IIb. n=18 : 1995. 8-1996. 6). A 50mg/kg/d dose of amoxcillin was aclministered, and that of CBS was 7-8mg/kg/d, and that of metronidazole was 20mg/kg/d. About one month after the cessation of treatment, eradication of H. pylori was evaluated with repeated endoscopic biopsy.
RESULTS
H. pylori eradication rate was 61.4% (35/57) in Group I, 90.9% (10/11) in Group IIa, and in the absence of H. pylori 88.9% (16/18) of Group IIb was done by means of an urease test, culture and a modified Giemsa stain (P=0.012). The overall proportion of eradication of H. pylori infection was 89.7% (26/29) by triple therapy and 61.4% (35/57) by dual therapy (P=0.007). However, there was no statistically significant difference in eradication rate between the 2-week triple therapy (IIb) and the Denol 4-week triple therapy (IIa)(P=0.86). Side effects : All patients in three treatment groups were tolerated well with little and mild side effects (P=0.258).
CONCLUSION
The 2-week triple therapy with CBS, amoxcillin, and metronidazole would be a highly effective and safe treatment regimen for H. pylori infection in children.