Thi Minh Phuong Do, Thi Huyen Trang Tran, Van Tinh Nguyen, Thi Phuong Mai Chu, Loi Nguyen, Kim Thanh Nguyen, Thi Bich Ngoc Hoang, Anh Le Huu Phuong, Yoshio Yamaoka, Linus Olson, Thi Viet Ha Nguyen
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This study evaluated the efficacy of first-line therapy with bismuth quadruple therapy in <i>H. pylori</i>-positive pediatric patients with peptic ulcers.</p>\n </section>\n \n <section>\n \n <h3> Materials and Methods</h3>\n \n <p>136 patients (aged between 8 and 17 years) diagnosed with active peptic ulcers with <i>H. pylori</i> infection were enrolled in this study. Patients with <i>H. pylori</i> 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 <i>H. pylori</i> was analyzed by the Epsilometer test. Treatment efficacy was evaluated at 12 weeks based on <i>H. pylori</i> eradication and peptic ulcer healing rates. <i>H. pylori</i> infection status was evaluated by a <sup>13</sup>C-urea breath test.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>The bismuth quadruple therapy with a 2-week PPI pretreatment and followed by prolonged PPI was highly successful in eradicating <i>H. pylori</i> infection and healing ulcers in pediatric patients with active peptic ulcer. 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引用次数: 0
摘要
背景：耐药菌株的不断增加、新型抗生素的缺乏以及儿科抗生素耐药感染可选方案的减少，给根除儿童幽门螺杆菌（H. pylori）带来了巨大挑战。本研究评估了幽门螺杆菌阳性的消化性溃疡儿科患者接受四联铋剂一线治疗的疗效。材料和方法：本研究共招募了136名确诊为幽门螺杆菌感染的活动性消化性溃疡患者（年龄在8至17岁之间）。幽门螺杆菌菌株对四环素和甲硝唑敏感的患者被分配接受铋剂四联疗法，包括质子泵抑制剂（PPI）、铋剂、四环素和甲硝唑。幽门螺杆菌的抗生素耐药性通过益普索试验进行分析。根据幽门螺杆菌根除率和消化性溃疡愈合率评估 12 周后的疗效。幽门螺杆菌感染状况通过 13C- 尿素呼气试验进行评估：大多数分离菌株对儿童常用抗生素的耐药率极高，包括克拉霉素（97.0%）和阿莫西林（84.6%），而对左氧氟沙星的耐药率较低（16.2%）。意向治疗组和按方案治疗组的根除疗法总体成功率分别为86.0%和89.3%。6周和12周时，所有患者的消化性溃疡愈合率分别为75.0%和97.7%。所有病例均未出现令人不悦的不良反应，消化性溃疡症状随时间推移稳步减轻：结论：铋剂四联疗法加上为期两周的 PPI 预处理和随后的长期 PPI，在根除幽门螺杆菌感染和治愈活动性消化性溃疡儿童患者的溃疡方面非常成功。对于幽门螺杆菌阳性的消化性溃疡儿科患者，尤其是对阿莫西林和克拉霉素耐药率较高的人群，这可能更适合作为一线经验性治疗方案。
Efficacy of Bismuth Quadruple Therapy in the Treatment of Helicobacter pylori-Infected Peptic Ulcer Children in Vietnam
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.
期刊介绍：
Helicobacter is edited by Professor David Y Graham. The editorial and peer review process is an independent process. Whenever there is a conflict of interest, the editor and editorial board will declare their interests and affiliations. Helicobacter recognises the critical role that has been established for Helicobacter pylori in peptic ulcer, gastric adenocarcinoma, and primary gastric lymphoma. As new helicobacter species are now regularly being discovered, Helicobacter covers the entire range of helicobacter research, increasing communication among the fields of gastroenterology; microbiology; vaccine development; laboratory animal science.
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