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P0547 ESOMEPRAZOLE BASED TRIPLE THERAPY DIRECTED BY ANTIBIOTIC SUSCEPTIBILITY TESTING FOR ERADICATION OF HELICOBACTER PYLORI INFECTION

Siegert, T.1; Antos, D.1; Kappler, M.1; Alberer, M.1; Buderus, S.2; Ruessmann, H.3; Koletzko, S.1

Journal of Pediatric Gastroenterology and Nutrition: June 2004 - Volume 39 - Issue - p S264-S265
ABSTRACTS: Poster Session Abstracts
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1Dr. von Haunersches Kinderspital of the Ludwig-Maximilians-University of Munich, Gastroenterology, Munich,2University Children’s Hospital of Bonn, Gastroenterology, Bonn,3Max von Pettenkofer Institute of the Ludwig-Maximilians-University of Munich, Microbiology, Munich, Germany

Submitted by: tsiegert@kk-i.med.uni-muenchen.de

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.

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Reference(S):

Drumm et al. J Pediatr Gastroenterol Nutr 2000;30:207–13
    © 2004 Lippincott Williams & Wilkins, Inc.