Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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Index Copernicus  – 161.11; MEiN – 140 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2016, vol. 25, nr 4, July-August, p. 701–708

doi: 10.17219/acem/38554

Publication type: original article

Language: English

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Assessment of Sequential and Standard Triple Therapy in Treatment of Helicobacter pylori Infection in Children Dependent on Bacteria Sensitivity to Antibiotics

Barbara M. Iwańczak1,A,C,D,E,F, Agnieszka Borys-Iwanicka1,A,B,C,D,E,F, Monika Biernat2,B,C,F, Grażyna Gościniak2,C,E,F

1 Department of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Poland

2 Department of Microbiology, Wroclaw Medical University, Poland


Background. In the last decade a 10-day schema of sequential therapy of Helicobacter pylori infection based on proton pomp inhibitor (PPI), amoxicillin (AMO), clarithromycin (CLA) and metronidazole (MET) has been introduced. Many studies have emphasized greater efficacy of this therapy in comparison to the efficacy of the standard 7-day triple therapy (PPI + AMO + CLA or MET).
Objectives. The aim of the study was to assess the sequential and standard triple therapy.
Material and Methods. Sixty-nine children, aged 5 to 17 years, with symptoms of dyspepsia and gastric or duodenal ulcer were included in the study. The children were randomly divided into three groups. Group I – 23 children treated with PPI + AMO + CLA, group II – 23 children treated with PPI + AMO + MET, and group III – 23 children treated with sequential therapy. The diagnosis of Helicobacter pylori infection was based on histopathological evaluation of gastric mucosa sample and on culture. The sensitivity of bacterial strains to antibiotics was assessed based on E-tests. The efficacy of Helicobacter pylori eradication was assessed 6–8 weeks after the completion of the treatment.
Results. In children infected with Helicobacter pylori strains, which were sensitive to clarithromycin, the highest rate of eradication was obtained in the group treated with PPI + AMO + CLA (100%) and in the group treated with sequential therapy (90.48%), the lowest was in the group treated with PPI + AMO + MET.
Conclusion. Efficiency of treatment of Helicobacter pylori infection in children depended on sensitivity of the strains to clarithromycin. Sensitivity to metronidazole did not influence significantly the eradication rate.

Key words

Helicobacter pylori, resistance, sequential therapy, standard triple therapy

References (33)

  1. International Agency for Research on Cancer. Infection with Helicobacter pylori. In: World Health Organization, ed. Schistosomes, liver flukes and Helicobacter pylori. Lyon: LARC, 1994, 177–202.
  2. Dzieniszewski J, Jarosz M oraz Grupa Robocza PTG-E do spraw zakażenia Helicobacter pylori. Ustalenia Grupy Roboczej PTG-E dotyczące postępowania w zakażeniu Helicobacter pylori – Consensus 2008. Gastroenterol Pol 2008, 15, 323–331.
  3. Koletzko S, Jones NL, Goodman KJ, Gold B, Rowland M, Cadranel S, Chong S, Colletti RB, Casswall T, Elitsur Y, Guarner J, Kalach N, Madrazo A, Megraud F, Oderda G: H. pylori Working Groups of ESPGHAN and NASPGHAN Evidence-based guidelines from ESPGHAN and NASPGHAN for Helicobacter pylori infection in children. J Pediatr Gastroenterol Nutr 2011, 53, 230–243.
  4. Malfertheiner P, Mègraud F, O’Morain C, Bazzoli F, El-Omar E, Graham D, Hunt R, Rokkas T, Vakil N, Kuipers EJ: The European Helicobacter study Group ( EHSG ): Current concept in the management of Helicobacter pylori infection: The Maastricht III Consensus Report. Gut 2007, 56, 772–781.
  5. Chey WD, Wong BC: American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol 2007, 102, 1808–1825.
  6. Graham DY, Lu H, Yamaoka Y: A report cord to grade Helicobacter pylori therapy. Helicobacter 2007, 12, 275–278.
  7. Graham DY, Shiotaui A: New concepts of resistance in the treatment of Helicobacter pylori infections. Nat Clin Pract Gastroenterol Hepat 2005, 5, 6, 321–331.
  8. Jafri NS, Hornung CA, Howden CW: Meta-analysis: Seqential therapy appears superior to standard therapy for Helicobacter pylori infection in patients naive to treatment. Am Intern Med 2008, 148, 923–931.
  9. Essa AS, Kramer JR, Graham DY, Treiber G: Meta-analysis: Four-drug, three-antibiotic, non-bismuth-containing “conconitant therapy” versus triple therapy for Helicobacter pylori eradication. Helicobacter 2009, 4, 109–118.
  10. Tong JL, Ran ZH, Shen J, Xiao SD: Sequential therapy vs. standard triple therapies for Helicobacter pylori infection: A meta-analysis. J Clin Pharm Ther 2009, 34, 41–53.
  11. Wu DC, Hsu PI, Wu JY, Opekun AR, Kuo CH, Wu IC, Wang SS, Chen A, Hung WC, Graham DY: Sequential and concomitant therapy with four drugs is equally effective for eradication of H. pylori infection. Clin Gastroenterol Hepatol 2010, 8, 36–41.
  12. Albrecht P, Kotowska M, Szajewska H: Sequential therapy compared with standard triple therapy for Helicobacter pylori eradication in children: A double-blind, randomizated, controlled trial. J Pediatr 2011, 159, 45–49.
  13. Fuccio L, Eusebi LH, Bazzoli F: Can sequential therapy for Helicobacter pylori eradication overcome clarithromycine resistance? Date still do not support conclusions. Am J Gastroenterol 2010, 105, 1674–1675.
  14. Fischbach L, Evans EL: Meta-analysis: The effect of antibiotic resistance status on the efficacy of triple and quodruple first-line therapies for Helicobacter pylori. Aliment Pharmacol Ther 2007, 26, 343–357.
  15. Graham DY, Fischbach L: Helicobacter pylori treatment in the era of increasing antibiotic resistance. Gut 2010, 57, 1143–1153.
  16. Schwarzer A, Bontems P, Urruzuno P, Kalach N, Iwańczak B, Roma-Glannikou E, Sykora J, Kindreman A, Casswali T, Koletzko S: Sequental therapy as first line treatment in children with new diagnosed symptomatic H. pylori infection. Helicobacter 2011, 16, Suppl 1, 85, Abstract no.: WS4.2.
  17. Łaszewicz W: Wyniki badań nad zakażeniem Helicobacter pylori. Trans Humana Białystok 2004.
  18. Mégraud F: H. pylori antibiotic resistance: Prevalence, importance and advances in testing. Gut 2004, 53, 1374–1384.
  19. Koletzko S, Richy F, Bontems P, Crone J, Kalach N, Monteiro ML, Gottrand F, Celińska-Cedro D, RomaGiannikou E, Orderda G, Kolacek S, Urruzuno P, Martinez-Gómez MJ, Casswall T, Ashorn M, Bodanszky H, Mégraud F: Prospective multicenter study on antibiotic resistance of Helicobacter pylori strains obtained from children living in Europe. Gut 2006, 55, 1711–1716.
  20. Dixon MF, Genta RM, Yardley JH, Correa P: Classification and grading of gastritis. The up date Sydney System. International Workshop on the Histopathology of Gastritis. Houston 1994. Am J Surg Pathol 1996, 20, 1161–1181.
  21. Schwarzer A, Urruzuno P, Iwańczak B, Martinez-Gomez MZ, Kalach N, Roma-Giannikou E, Liptay S, Bontems P, Buderus S, Wenzl TG, Koletzko S: New effective treatment regimen for children infected with a double-resistant Helicobacter pylori strain. J Pediatr Gastroenterol Nutr 2011, 52, 4, 424–428.
  22. Malfertheiner P, Bazzoli F, Delchier JC, Celiński K, Giguère M, Rivière M, Mègraud F: Helicobacter pylori eradication with a capsule contaiming bismuth subcitrate potassium, metronidazole and tetracyclin-based triple therapy: A randomised, open-label, non-inferiority, phase 3 trial. Lancet 2011, 377, 905–913.
  23. Romano M, Cuomo A, Gravina AG, Miranda A, Iovene MR, Tiso A, Sica M, Rocco A, Salverno R, Marmo R, Federico A, Nardone G: Empirical levofloxacin-containing versus clarithromycin-containing sequential therapy for. Helicobacter pylori eradication: A randomised trial. Gut 2010, 59, 1465–1470.
  24. Molina-Infante J, Perez-Gallardo B, Fernandez-Bermejo M, Hernandez-Alonso M, Vinagre B, Duenas C, Mateos-Rodriguez JM, Gonzalez-Garcio G, Abadia EG, Gispert JP: Clinical trial: Clarithromycin vs. levofloxacin in first-line triple and sequential regiment for Helicobacter pylori eradication. Aliment Pharmacol Ther 2010, 31, 1077–1084.
  25. Paoluzi OA, Visconti E, Andrei F, Tosti C, Lionetti R, Grasso E, Ronaldi R, Stroppa I, Pallone F: Ten and eight-day sequential therapy in comparison to standard triple therapy for eradicating Helicobacter pylori infection: A randomized controlled study on efficacy and tolerability. J Clin Gastroenterol 2010, 44, 261–266.
  26. Bontems P, Kalach N, Oderda G, Salame A, Muyshont L, Miendie DY, Raymond J, Cadranel S, Scaillon M: Sequential theray versus tailoerd triple therapies for Helicobacter pylori infection in children. J Pediatr Gastroenterol Nutr 2011, 53, 646–650.
  27. Hunt RH, Xiao SD, Mégraud F, Leon-Barua R, Bazzoli F, van der Merwe S, Vaz Coelhol G, Fock M, Fedain S, Cohen H, Malfartheiner P, Vakil N, Hamid S, Goh KL, Wong BCY, Krabshuis J: Helicobacter pylori in developing countries. World Gastroenterol Organization Global Guideline 2010, 1–15.
  28. Gościniak G, Iwańczak B, Przondo-Mordarska A, Grabińska J, Iwańczak F: Ocena wrażliwości szczepów Helicobacter pylori na wybrane chemioterapeutyki. Pediatr Pol 2001, 76, 873–877.
  29. Gościniak G: Rodzaj Helicobacter pylori – implikacje kliniczne i narastający problem oporności. Pediatr Współ Gastroenter Hepat Żyw Dziecka 2010, 12, 41–44.
  30. Gościniak G, Biernat M, Błaszczuk J, Kania A, Grabińska J, Poniewierka E: The primary resistance of H. pylori strains in adults. Helicobacter 2011, 16, Suppl 1, 120 Abstract no.: PO 7.15.
  31. Nagahara A, Miwa H, Yamada T, Kurosawa A, Ohkura R, Sato N: Five-day proton pump inhibitor based quadruple therapy regimen is more effective than 7-day triple therapy regimen for Helicobacter pylori infection. Aliment Pharmacol Ther 2001, 15, 417–421.
  32. Gisbert JP, Calvet X: Review article: Non–bismuth quadruple (concomitant) therapy for eradication Helicobacter pylori. Aliment Pharmacol Ther 2011, 34, 604–617.
  33. Malfertheiner P, Megraund F, O’Morain CA, Atherton J, Axon ATR, Bazzoli F, Gensini GF, Gisbert JP, Graham DY, Rokkas Th, El-Omar EM, Kuipers EJ: Managemant of Helicobacter pylori infection – the Maastricht IV / Florence Consensus Report. Gut 2012, 61, 646–664.