ABSTRACTS: Poster Session Abstracts
Introduction: It has been recommended to perform antibiotic susceptibility testing prior to first therapy in symptomatic children with H. pylori infection. Between 6/1998 and 12/2000 we used omeprazole-based one-week triple therapy with amoxicillin (AMO) and clarithromycin (CLA) or metronidazole (MET) directed by antibiogram. Intention-to-treat analysis in 46 children revealed an eradication rate of 87% after exclusion of patients with double resistant strains.
Objective: To investigate the effectiveness of esomeprazole (ESO) based therapy for eradication of H. pylori in children directed by antibiogram.
Methods: Between 12/2000 and 7/2003 symptomatic children with a culture proven H. pylori infection and successful antibiogram were considered for inclusion. Patients with a strain resistant to both, MET and CLA, a previous H. pylori therapy or without informed consent of the parents were excluded. The daily dose was adapted to body weight: ESO (10 – 20 mg bid) AMO (500 – 1000 mg bid), CLA (250 – 500 mg bid). MET (200 – 400 mg bid) was given instead of CLA in five cases harbouring a CLA resistant strain. Six weeks later success of eradication was investigated by 13UBT. Adverse events were assessed during therapy by a symptom diary.
Results: Fifty-eight children with median age of 11.4 years (range 2.2–17.7 years, 61% female, 60% immigrants) were included. In five patients (9%) H. pylori was resistant to CLA, in 9 (16%) to MET. Eradication was successful in 49 of 53 (92%) children receiving ESO, AMO, CLA and in all five children treated with MET instead of CLA, resulting in an overall eradication rate of 93% (intention-to-treat analysis, 95% CI: 0.86–0.95). No serious adverse events were observed. All four treatment failures occurred in immigrants with major language problems, two of them were obviously non-compliant.
Conclusion: We conclude that esomeprazole-based one-week triple therapy directed by antibiogram is highly effective for eradication of H. pylori infection in children.
Drumm et al. J Pediatr Gastroenterol Nutr 2000;30:207–13