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Sequential Therapy Versus Tailored Triple Therapies for Helicobacter pylori Infection in Children

Bontems, Patrick*; Kalach, Nicolas; Oderda, Giuseppina; Salame, Assad*; Muyshont, Laurence*; Miendje, D. Yvette§; Raymond, Josette||; Cadranel, Samy*; Scaillon, Michèle*

Journal of Pediatric Gastroenterology & Nutrition: December 2011 - Volume 53 - Issue 6 - p 646–650
doi: 10.1097/MPG.0b013e318229c769
Original Articles: Gastroenterology

Aims: The aim of the study was to compare sequential versus tailored triple therapy regimens on Helicobacter pylori (H pylori) eradication rates in children and to assess the effect of antimicrobial susceptibility.

Patients and Methods: Prospective, open-label, multicenter study. Children received randomly either a 10-day sequential treatment comprising omeprazole (OME) with amoxicillin for 5 days and OME, clarithromycin (CLA), and metronidazole (MET) for the remaining 5 days, or a 7-day triple therapy comprising OME with amoxicillin and CLA in cases of a CLA-susceptible strain or MET in cases of CLA-resistant strain. H pylori eradication was assessed by 13C-urea breath test.

Results: One hundred sixty-five children, 95 girls and 70 boys, of median age 10.4 years, were included. The intention-to-treat (ITT) eradication rate was 76.9% (sequential 68/83 = 81.9%, triple therapy 59/82 = 71.9%, ns), and the per-protocol (PP) eradication rate was 84.6% (sequential 68/77 = 88.3%, triple therapy 59/73 = 81.8%, ns). Eradication rates tended to be higher using the sequential treatment, but the difference was only statistically significant for ITT analysis in children harboring both CLA- and MET-susceptible strains (87.8% vs 68.5%, odds ratio [OR] 3.3, P = 0.03). Both ITT and PP eradication rates were significantly lower with sequential treatment in CLA-resistant compared with CLA-susceptible strains (ITT: 56.2% vs 72.7%, OR 5.5, P = 0.008; PP 64.3% vs 80.0%, OR 7.9, P = 0.009). Both treatments were well tolerated.

Conclusions: Sequential treatment is greatly effective for eradicating H pylori in children except in CLA-resistant strains. Sequential treatment can be used as a first-line therapy, but only in areas with a low CLA resistance rate.

*Pediatric Gastroenterology-Hepatology, Queen Fabiola Children's University Hospital, Brussels, Belgium

St Antoine Pediatric Clinic, Groupe Hospitalier de l’Institut Lillois, Lille, France

Pediatric Department, University of Piemonte Orientale, Novara, Italy

§Microbiology Department, Brugmann University Hospital, Brussels, Belgium

||Microbiology Department, Paris V University, Cochin-Hôtel Dieu Hospital, Paris, France.

Address correspondence and reprint requests to Dr Patrick Bontems, Pediatric Gastroenterology-Hepatology, Queen Fabiola Children's University Hospital, Brussels, Belgium (e-mail:

Received 16 December, 2010

Accepted 5 March, 2011

The authors report no conflicts of interest.

Copyright 2011 by ESPGHAN and NASPGHAN