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• W1997202397 abstract "Francavilla et al1Francavilla R. Lionetti E. Castellaneta S. Margiotta M. Piscitelli D. Lorenzo L. et al.Clarithromycin-resistant genotypes and eradication of Helicobacter pylori.J Pediatr. 2010; 157: 228-232Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar reported that sequential therapy is better than standard triple therapy to eradicate Helicobacter pylori infection in children, especially to improve the control of clarithromycin-resistant strains. The consensus of North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and Maastricht III recommend 1-week proton pump inhibitor-based triple therapy as the standard first-line choice to achieve eradication rates in the range of 75% to 85% for pediatric H pylori infection.2Gold B.D. Colletti R.B. Abbott M. Czinn S.J. Elitsur Y. Hassall E. et al.Helicobacter pylori infection in children: recommendations for diagnosis and treatment.J Pediatr Gastroenterol Nutr. 2000; 31: 490-497Crossref PubMed Scopus (302) Google Scholar, 3Malfertheiner P. Megraud F. O’Morain C. Bazzoli F. El-Omar E. Graham D. et al.Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report.Gut. 2007; 56: 772-781Crossref PubMed Scopus (1740) Google Scholar Nevertheless, the eradication rate of such first-line therapy has progressively decreased since the emergence of clarithromycin-resistant strains.4Oderda G. Shcherbakov P. Bontems P. Urruzuno P. Romano C. Gottrand F. et al.European Pediatric Task Force on Helicobacter pylori: results from the Pediatric European Register for Treatment of Helicobacter pylori (PERTH).Helicobacter. 2007; 12: 150-156Crossref PubMed Scopus (86) Google Scholar In Taiwan, a high rate of H pylori isolates are clarithromycin-resistant.5Yang Y.J. Yang J.C. Jeng Y.M. Chang M.H. Ni Y.H. Prevalence and rapid identification of clarithromycin-resistant Helicobacter pylori isolates in children.Pediatr Infect Dis J. 2001; 20: 662-666Crossref PubMed Scopus (32) Google Scholar Accordingly, it is promising to apply a new strategy such as sequential therapy to improve the eradication rate by overcoming the antibiotic resistance.We conducted a randomized trial to compare the eradication rates between a 10-day sequential therapy (lansoprazole [1 mg/kg/day] plus amoxicillin [50 mg/kg/day] for 5 days) followed by lansoprazole [1 mg/kg/day] plus clarithromycin [15 mg/kg/day] and metronidazole [20 mg/kg/day]; and a 7-day triple therapy (lansoprazole [1 mg/kg/day] plus amoxicillin [50 mg/kg/day] and clarithromycin [15 mg/kg/day]) for the children infected with H pylori (age range 4-12 years). We found that the sequential therapy is better, but not statistically significantly different on intention-to-treat analysis (24/34 [70.1%] vs. 34/57 [59.6%], P = .43) from triple therapy. However, it was striking to show that 21% (7/34) of our children receiving the sequential therapy had poor drug compliance (defined as less than 75% tablets used). Within the group, the eradication rate was significantly higher in children with good drug compliance than in those with poor compliance (23/27 [85.2%] vs. 1/7 [14.3%], P = .001).We agree that sequential therapy is a powerful strategy to improve H pylori eradication in children. However, because of the rather complex 10-day regimens of sequential therapy, need for adherence to the therapies should be emphasized to parents. Francavilla et al1Francavilla R. Lionetti E. Castellaneta S. Margiotta M. Piscitelli D. Lorenzo L. et al.Clarithromycin-resistant genotypes and eradication of Helicobacter pylori.J Pediatr. 2010; 157: 228-232Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar reported that sequential therapy is better than standard triple therapy to eradicate Helicobacter pylori infection in children, especially to improve the control of clarithromycin-resistant strains. The consensus of North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and Maastricht III recommend 1-week proton pump inhibitor-based triple therapy as the standard first-line choice to achieve eradication rates in the range of 75% to 85% for pediatric H pylori infection.2Gold B.D. Colletti R.B. Abbott M. Czinn S.J. Elitsur Y. Hassall E. et al.Helicobacter pylori infection in children: recommendations for diagnosis and treatment.J Pediatr Gastroenterol Nutr. 2000; 31: 490-497Crossref PubMed Scopus (302) Google Scholar, 3Malfertheiner P. Megraud F. O’Morain C. Bazzoli F. El-Omar E. Graham D. et al.Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report.Gut. 2007; 56: 772-781Crossref PubMed Scopus (1740) Google Scholar Nevertheless, the eradication rate of such first-line therapy has progressively decreased since the emergence of clarithromycin-resistant strains.4Oderda G. Shcherbakov P. Bontems P. Urruzuno P. Romano C. Gottrand F. et al.European Pediatric Task Force on Helicobacter pylori: results from the Pediatric European Register for Treatment of Helicobacter pylori (PERTH).Helicobacter. 2007; 12: 150-156Crossref PubMed Scopus (86) Google Scholar In Taiwan, a high rate of H pylori isolates are clarithromycin-resistant.5Yang Y.J. Yang J.C. Jeng Y.M. Chang M.H. Ni Y.H. Prevalence and rapid identification of clarithromycin-resistant Helicobacter pylori isolates in children.Pediatr Infect Dis J. 2001; 20: 662-666Crossref PubMed Scopus (32) Google Scholar Accordingly, it is promising to apply a new strategy such as sequential therapy to improve the eradication rate by overcoming the antibiotic resistance. We conducted a randomized trial to compare the eradication rates between a 10-day sequential therapy (lansoprazole [1 mg/kg/day] plus amoxicillin [50 mg/kg/day] for 5 days) followed by lansoprazole [1 mg/kg/day] plus clarithromycin [15 mg/kg/day] and metronidazole [20 mg/kg/day]; and a 7-day triple therapy (lansoprazole [1 mg/kg/day] plus amoxicillin [50 mg/kg/day] and clarithromycin [15 mg/kg/day]) for the children infected with H pylori (age range 4-12 years). We found that the sequential therapy is better, but not statistically significantly different on intention-to-treat analysis (24/34 [70.1%] vs. 34/57 [59.6%], P = .43) from triple therapy. However, it was striking to show that 21% (7/34) of our children receiving the sequential therapy had poor drug compliance (defined as less than 75% tablets used). Within the group, the eradication rate was significantly higher in children with good drug compliance than in those with poor compliance (23/27 [85.2%] vs. 1/7 [14.3%], P = .001). We agree that sequential therapy is a powerful strategy to improve H pylori eradication in children. However, because of the rather complex 10-day regimens of sequential therapy, need for adherence to the therapies should be emphasized to parents. Clarithromycin-Resistant Genotypes and Eradication of Helicobacter PyloriThe Journal of PediatricsVol. 157Issue 2PreviewTo compare the eradication rates among the different point mutations and the efficacy of triple therapy and a sequential regimen according to genotypic resistance. Full-Text PDF ReplyThe Journal of PediatricsVol. 159Issue 4PreviewYang and Sheu1 report their experience in the use of sequential therapy versus triple therapy in children with Helicobacter pylori infection and raise some concerns about efficacy and compliance. Full-Text PDF" @default.
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