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Efficacy of Bismuth Quadruple Therapy in the Treatment of Helicobacter pylori-Infected Peptic Ulcer Children in Vietnam.

Author information

Affiliations

  • 1. Department of Pediatrics, Hanoi Medical University, Hanoi, Vietnam.
      Authors
    • Do TMP 1, 3
    • Chu TPM 1, 3
    • Nguyen TVH 1, 3
    (3 authors)
  • 2. Center for Stem Cell Research and Application, 108 Hospital, Hanoi, Vietnam.
      Authors
    • Tran THT 2
    • Phuong ALH 2
    (2 authors)
  • 3. Department of Gastroenterology, National Children's Hospital, Hanoi, Vietnam.
      Authors
    • Do TMP 1, 3
    • Nguyen VT 3
    • Chu TPM 1, 3
    • Nguyen L 3
    • Nguyen KT 3
    • Nguyen TVH 1, 3
    (6 authors)
  • 4. Department of Microbiology, National Children's Hospital, Hanoi, Vietnam.
      Authors
    • Hoang TBN 4
    (1 author)
  • 5. Department of Environmental and Preventive Medicine, OIta University Faculty of Medicine, Yufu, Japan.
      Authors
    • Yamaoka Y 5
    (1 author)
    • Show all (6)

ORCIDs linked to this article

Helicobacter, 01 Nov 2024, 29(6):e13149
https://doi.org/10.1111/hel.13149 PMID: 39500715 

Abstract 

Background

The continuous increase in drug-resistant strains, the lack of novel antibiotics, and the fewer options available to combat antibiotic-resistant infections in pediatrics pose significant challenges to the eradication of Helicobacter pylori (H. pylori) in children. This study evaluated the efficacy of first-line therapy with bismuth quadruple therapy in H. pylori-positive pediatric patients with peptic ulcers.

Materials and methods

136 patients (aged between 8 and 17 years) diagnosed with active peptic ulcers with H. pylori infection were enrolled in this study. Patients with H. pylori strain sensitive to tetracycline and metronidazole were assigned to bismuth quadruple therapy, including a proton pump inhibitor (PPI), bismuth, tetracycline, and metronidazole. Antibiotic resistance of H. pylori was analyzed by the Epsilometer test. Treatment efficacy was evaluated at 12 weeks based on H. pylori eradication and peptic ulcer healing rates. H. pylori infection status was evaluated by a 13C-urea breath test.

Results

Most isolates showed extremely high rates of resistance to commonly prescribed antibiotics used for children, including clarithromycin (97.0%) and amoxicillin (84.6%), while the low rate of resistance to levofloxacin (16.2%). The overall success rate of eradication therapy in the intention-to-treat and the per-protocol group were 86.0% and 89.3%, respectively. Peptic ulcer healing rates for total patients at 6 weeks and 12 weeks were 75.0% and 97.7%, respectively. There were no entail unpleasant adverse events, and peptic ulcer symptoms decreased steadily over time in all cases.

Conclusions

The bismuth quadruple therapy with a 2-week PPI pretreatment and followed by prolonged PPI was highly successful in eradicating H. pylori infection and healing ulcers in pediatric patients with active peptic ulcer. This might be preferable as a first-line empiric treatment regimen for H. pylori-positive pediatric patients with peptic ulcers, especially in populations with high rates of resistance to amoxicillin and clarithromycin.

Full text links 

Read article at publisher's site: https://doi.org/10.1111/hel.13149

Read article for free, from open access legal sources, via Unpaywall: https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/hel.13149Unpaywall

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Funding 

Funders who supported this work.

the Ministry of Science and Technology of Vietnam - MOST (NĐT.83.GB/20).