Treatment of Pediatric Helicobacter pylori Infection
Abstract
:1. Introduction
2. Methods
3. Results
3.1. First-Line Treatment
Published Year | Region | Helicobacter pylori Antimicrobial Susceptibility | ||||
---|---|---|---|---|---|---|
Susceptible to CLA and MET | Resistant to MET, Susceptible to CLA | Resistant to CLA, Susceptible to MET | Resistant to CLA and MET | Unknown | ||
2016 [10] | Europe | PPI-AMO-CLA 14 d | PPI-AMO-MET 14 d | PPI-high dose AMO-MET 14 d | ||
Sequential therapy 10 d # | BIS-PPI-AMO-MET * 14 d # | BIS-PPI-AMO-MET * 14 d # | BIS-PPI-AMO-MET 14 d # | |||
Concomitant therapy for 14 d *# | ||||||
Doses (morning dose/evening dose) of PPI and antibiotics are calculated based on the body weight and age: | ||||||
Body weight | 15–24 kg | 25–34 kg | >35 kg | |||
PPI | 20 mg/20 mg | 30 mg/30 mg | 40 mg/40 mg | |||
The PPI dose refers to esomeprazole and omeprazole and should be adapted if other PPIs are used. | ||||||
AMO | 500 mg/500 mg | 750 mg/750 mg | 1000 mg/1000 mg | |||
High dose AMO | 750 mg/750 mg | 1000 mg/1000 mg | 1500 mg/1500 mg | |||
CLA | 250 mg/250 mg | 500 mg/250 mg | 500 mg/500 mg | |||
MET | 250 mg/250 mg | 500 mg/250 mg or 375 mg/375 mg | 500 mg/500 mg | |||
Age | <10 years | >10 years | ||||
BIS | 262 mg QID | 524 mg QID | ||||
Bismuth in the United States and Canada comes as bismuth subsalicylate. | ||||||
2019 [18] | Korea | PPI-AMO-CLA 14 d | PPI-AMO-MET 14 d | PPI-high dose AMO-MET 14 d | ||
Sequential therapy 10 d # | BIS-PPI-AMO (TET)-MET 14 d *# | BIS-PPI-AMO (TET)-MET 14 d *# | BIS-PPI-AMO (TET)-MET 14 d *# | |||
Concomitant therapy 14 d *# | ||||||
The doses of PPI, Amoxicillin, Clarithromycin, Metronidazole, and Bismuth are the same as stated above except for esomeprazole or omeprazole (1.5–2.5 mg/kg/d) are also mentioned. | ||||||
TET | 500 mg QID (>12 years old, >40 kg) | |||||
2020 [5] | Japan | PPI-AMO-CLA 7–14 d | PPI -AMO-MET 7–14 d | PPI-AMO-CLA 7–14 d | ||
Twice daily | Maximum daily dose (mg/day) | |||||
PPI | ||||||
Lansoprazole | 1.5 mg/kg/day | 60 | ||||
Omeprazole | 1.0 mg/kg/day | 40 | ||||
Rabeprazole | 0.5 mg/kg/day | 20 | ||||
Esomeprazole | ≥4 years old Body weight < 30 kg | 20 mg/day | 40 | |||
Bodyweight ≥ 30 kg | 40 mg/day | |||||
AMO | 50 mg/kg/day | 1500 | ||||
CLA | 15–20 mg/kg/day | 800 | ||||
MET | 10–20 mg/kg/day | 500 |
Study | Region | Study Period | Follow-Up Case Number | Treatment | Eradication Rate |
---|---|---|---|---|---|
Francavilla et al., 2005 [21] | Italy | 2002 to 2004 | 74 (Age 3.3–18 years; median age 12.3 years) | Triple therapy for 7 days OME + AMO + MET | 75.7% (28/37) |
Sequential therapy for 10 days OME + AMO for 5 days followed by OME + CLA + TIN for 5 days | 97.3% (36/37) | ||||
The method that detects the eradication of H. pylori: 13C-urea breath test, at least 4 weeks after the end of therapy | |||||
Lerro et al., 2006 [26] (abstract) | Italy | Not available | 25 (Median age 12.3 years) | Triple therapy for 7 days OME + AMO + TIN | 80% (20/25) |
25 (Median age 11.9 years) | Sequential therapy for 10 days OME + AMO for 5 days followed by OME + CLA + TIN for 5 days | 92% (23/25) | |||
The method that detects the eradication of H. pylori: 13C-urea breath test, 6 weeks after the end of therapy | |||||
Hurduc et al., 2007 | Romania | Not available | 135 | Triple therapy for 7–14 days * PPI + 2 antibiotics (type of medication was not reported) | 80% (36/45) |
Sequential therapy for 10 days * OME + AMO for 5 days followed by OME + CLA + TIN for 5 days | 86.7% (39/45) | ||||
Lu et al., 2010 [27] | China | 2006 to 2009 | 33 (Mean age 10.2 ± 2.8 years) | Standard triple therapy for 10 days OME + AM + CLA | 78.8% (26/33) |
38 (Mean age 10.7 ± 2.4 years) | Sequential therapy for 10 days OME + AMO for 5 days followed by OME + CLA+ TIN for 5 days | 94.7% (36/38) | |||
The method that detects the eradication of H. pylori: 13C-urea breath test, at least 4 weeks after the end of therapy | |||||
Anania et al., 2011 [23] (abstract) | Italy | Not available | 15 (Age 5.8–16.7 years; median age 11 years) | Concomitant therapy for 5 days * OME + AMO + CLA + TIN | 93.3% (14/15) |
15 (Age 4.8–14.1 years; median age 7.6 years) | Sequential therapy for 10 days * OME + AMO for 5 days followed by OME + CLA + TIN for 5 days | 86.7% (13/15) | |||
The method that detects the eradication of H. pylori: 13C-urea breath test, 8 weeks after the end of therapy | |||||
Bontems et al., 2011 [28] | Belgian, France, Italy | 2007 to 2009 | 150 (Median age 10.4 years) | Standard triple therapy for 7 days OME + AMO + CLA or MET for CLA-resistant strains | 80.8% (59/73) |
Standard sequential therapy for 10 days OME + AMO for 5 days followed by OME + CLA + MET for 5 days | 88.3% (68/77) | ||||
The method that detects the eradication of H. pylori: 13C-urea breath test, at least 8 weeks after the end of therapy | |||||
Albrecht et al., 2011 [29] | Poland | 2006 to 2009 | 103 (Age 3 to 18 years) | Standard triple therapy for 7 days + Placebo for 3 days OME + AMO + CLA for 7 days followed by placebo for 3 days | 68.6% (35/51) |
Sequential therapy for 10 days OME + AMO for 5 days followed by OME + CLA + TIN for 5 days | 86.5% (45/52) | ||||
The method that detects the eradication of H. pylori: 13C-urea breath test, 6–8 weeks after the end of therapy | |||||
Liu et al., 2011 [30] (abstract) | China | Not available | 100 | Standard triple therapy for 10 days * OME + AMO + CLA | 69.0% (33) |
Triple therapy for 10 days * OME + AMO + MET | 76.7% (33) | ||||
Standard sequential therapy for 10 days * OME + AMO for 5 days followed by OME + CLA + MET for 5 days | 91.2% (34) | ||||
The method that detects the eradication of H. pylori: 13C-urea breath test, 4 weeks after the end of therapy | |||||
Hong et al., 2012 [31] | Seoul, Korea | 2004 to 2012 | 62 (Age 3.1–16.6 years; mean age 11.0±3.2 years) | Standard triple therapy for 14 days OME + AMO + CLA | 67.7% (42/62) |
56 (Age 2.7–18.6; mean age 11.0±3.3 years) | Bismuth-based quadruple therapy for 7 days OME + AMO + MET + BIS citrate | 83.9% (47/56) | |||
The method that detects the eradication of H. pylori: 13C-urea breath test, 4 weeks after the end of therapy | |||||
Huang et al., 2012 [32] (abstract) | Not available | Not available | 199 | Triple therapy for 7 days OME + AMC + CLA | 71.4% |
Triple therapy for 10 days | 67.3% | ||||
Triple therapy for 14 days | 82.0% | ||||
Sequential therapy for 10 days OME + AMC for 5 days followed by OME + CLA + MET for 5 days | 90.2% | ||||
The method that detects the eradication of H. pylori: 13C-urea breath test, 4 weeks after the end of therapy | |||||
Hojsak, et al., 2012 [33] | Croatia | 2001 to 2010 | 186 (Age 1.08–18.8 years; median age 12.9 years) | Triple therapy for 7–10 days PPI 1–2 mg/kg/day + AMO + MET or CLA | 81.2% (151/186) |
The method that detects the eradication of H. pylori: urea breath test or repeated endoscopy with culture | |||||
Huang et al., 2013 [34] | China | 2008 to 2010 | 318 (Age 3–16 years) | Standard triple therapy for 7 days OME + AMO + CLA | 70.9% (73/103) |
Standard triple therapy for 10 days | 77.8% (84/108) | ||||
Standard sequential therapy for 10 days OME + AMO for 5 days followed by OME + CLA + MET for 5 days | 89.7% (96/107) | ||||
The method that detects the eradication of H. pylori: stool antigen test, 4 weeks after the end of therapy | |||||
Ali Habib HS et al., 2013 [35] | Jeddah, Saudi Arabia | Not available | 16 (Age 12–15 years, male) | Standard triple therapy for 10 days rabeprazole + AMO + CLA | 55.6% (5/9) |
Sequential therapy for 10 days rabeprazole + AMO for 5 days followed by rabeprazole + CLA + TIN for 5 days | 57.1% (4/7) | ||||
The method that detects the eradication of H. pylori: 14C-urea breath test, 6 weeks after the end of therapy | |||||
Laving et al., 2013 [36] | Kenya | 2007 | 71 (Age 2–16 years; mean age 8.9 years) | Standard triple therapy for 10 days OME + AMO + CLA | 48.9% (22/45) |
Sequential therapy for 10 days OME + AMO for 5 days followed by OME + CLA + TIN for 5 days | 84.6% (22/26) | ||||
The method that detects the eradication of H. pylori: a stool antigen test and/or a repeat histology obtained at repeat endoscopy, 6 weeks after the end of therapy | |||||
Baysoy et al., 2013 [37] | Turkey | 2008 to 2010 | 61 (Age 4–18 years) | Standard triple therapy for 14 days LAN + AMO + CLA | 54.2% (13/24) |
Sequential therapy for 10 days LAN + AMO for 5 days followed by LAN + CLA+ ORN for 5 days | 48.6% (18/37) | ||||
The method that detects the eradication of H. pylori: 13C-urea breath test, 6–8 weeks after the end of therapy | |||||
Kutluk et al., 2014 [38] | Turkey | 2011 | 136 (Age 3–18 years) | Standard triple therapy for 10 days LAN + AMO + CLA | 55.7% (39/70) |
Standard sequential therapy for 10 days LAN + AMO for 5 days followed by LAN + CLA and MET for 5 days | 56.1% (37/66) | ||||
The method that detects the eradication of H. pylori: 13C-urea breath test, 4–6 weeks after the end of therapy | |||||
Schwarzer, et al., 2016 [39] | European, a registry from nine European centers | 2009 to 2011 | 209 (Age 3.1– 17.9 years) | Standard sequential therapy for 10 days ESO + AMO for 5 days followed by ESO + CLA + MET for 5 days (Dosage was chosen depending on weight: 15–24 kg, 25–34 kg, >35 kg) | 80.4% (168/209) |
The method that detects the eradication of H. pylori: 13C-urea breath test, by upper endoscopy with culture and histology, and/or by a monoclonal stool antigen test, 8–12 weeks after the end of therapy | |||||
Zhou et al., 2020 [40] | China | 2017 to 2018 | 228 (Age 6– 18 years) | Standard triple therapy for 14 days OME + AMO + CLA | 74.1% (43/58) |
Sequential therapy for 14 days OME + AMO for 7 days followed by OME + CLA + MET for 7 days | 69.5% (41/59) | ||||
Bismuth-based quadruple therapy for 14 days OME + AMO + MET + elemental BIS | 89.8% (53/59) | ||||
Standard concomitant therapy for 14 days OME + AMO + CLA + MET | 84.6% (44/52) | ||||
The method that detects the eradication of H. pylori: 13C-urea breath test, at least 4 weeks after the end of therapy |
3.1.1. Triple Therapy
3.1.2. Sequential Therapy
3.1.3. Concomitant Therapy
3.1.4. Bismuth-Based Quadruple Therapy
3.1.5. Adjuvant Therapy with Probiotics
3.2. Second-Line Treatment
3.3. Adverse Event
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Medication | Dosage | Study | Maximum Dose | |
---|---|---|---|---|
PPI | OME | 1 mg/kg/day | Francavilla et al., 2005 Lerro et al., 2006 Albrecht et al., 2011 Hong et al., 2012 Laving et al., 2013 Zhou et al., 2020 | 40 mg/day |
0.8 mg/kg/day | Lu et al., 2010 | |||
0.8–1.0 mg/kg/day | Huang et al., 2012 Huang et al., 2013 | |||
10 mg twice a day below 30 kg | Bontems et al., 2011 | |||
20 mg twice a day above 30 kg | ||||
LAN | 1 mg/kg/day | Baysoy et al., 2013 Kutluk et al., 2014 | 30 mg/day | |
Rabeprazole | 40 mg/day | Ali Habib HS et al., 2013 | ||
Antibiotics | AMO | 50 mg/kg/day | Francavilla et al., 2005 Lerro et al., 2006 Bontems et al., 2011 Albrecht et al., 2011 Hojsak, et al., 2012 Hong et al., 2012 Baysoy et al., 2013 Laving et al., 2013 Kutluk et al., 2014 Zhou et al., 2020 | 2 g/day |
40 mg/kg/day | Lu et al., 2010 | |||
30 mg/kg/day | Huang et al., 2013 | |||
1 g/day | Ali Habib HS et al., 2013 | |||
AMC | 50 mg/kg/day | Huang et al., 2012 | ||
CLA | 15 mg/kg/day | Francavilla et al., 2005 Lerro et al., 2006 Lu et al., 2010 Bontems et al., 2011 Hong et al., 2012 Baysoy et al., 2013 Laving et al., 2013 | 1 g/day | |
20 mg/kg/day | Albrecht et al., 2011 Hojsak, et al., 2012 Huang et al., 2012 Huang et al., 2013 Kutluk et al., 2014 Zhou et al., 2020 | |||
500 mg/day | Ali Habib HS et al., 2013 | |||
MET | 15 mg/kg/day | Francavilla et al., 2005 | ||
20 mg/kg/day | Kutluk et al., 2014 Zhou et al., 2020 | 1 g/day | ||
Bontems et al., 2011 Hojsak, et al., 2012 Hong et al., 2012 Huang et al., 2012 Huang et al., 2013 | 1.5 g/day | |||
TIN | 20 mg/kg/day | Francavilla et al., 2005 Lerro et al., 2006 Albrecht et al., 2011 Laving et al., 2013 | 1 g/day | |
15 mg/kg/day | Lu et al., 2010 | |||
1 g/day | Ali Habib HS et al., 2013 | |||
ORN | 30 mg/kg/day | Baysoy et al., 2013 | ||
BIS | bismuth citrate 8 mg/kg/day | Hong et al., 2012 | ||
elemental bismuth 6–8 mg/kg/day | Zhou et al., 2020 | 330 mg/day |
Published Year | Region | Helicobacter pylori Antimicrobial Susceptibility | ||||
---|---|---|---|---|---|---|
Past Treatment Regimen | Susceptible to CLA and MET | Resistant to MET, Susceptible to CLA | Resistant to CLA, Susceptible to MET | Unknown | ||
2016 [10] | Europe | PPI-AMO-CLA | PPI-AMO-MET | ◎ | - | ◎ |
PPI-AMO-MET | PPI-AMO-CLA | - | Treatment like double resistance (#) | |||
Sequential therapy | ◎ | - | - | |||
Doses (morning dose/evening dose) of PPI and antibiotics are calculated based on the body weight and age: | ||||||
Body weight | 15–24 kg | 25–34 kg | >35 kg | |||
PPI | 20 mg/20 mg | 30 mg/30 mg | 40 mg/40 mg | |||
The PPI dose refers to esomeprazole and omeprazole and should be adapted if other PPIs are used. | ||||||
AMO | 500 mg/500 mg | 750 mg/750 mg | 1000 mg/1000 mg | |||
High dose AMO | 750 mg/750 mg | 1000 mg/1000 mg | 1500 mg/1500 mg | |||
CLA | 250 mg/250 mg | 500 mg/250 mg | 500 mg/500 mg | |||
MET | 250 mg/250 mg | 500 mg/250 mg or 375 mg/375 mg | 500 mg/500 mg | |||
Age | <10 years | >10 years | ||||
BIS | 262 mg QID | 524 mg QID | ||||
Bismuth in the United States and Canada comes as bismuth subsalicylate. | ||||||
2019 [18] | Korea | PPI-AMO-CLA | PPI-AMO-MET | ◎ | - | ◎ |
PPI-AMO-MET | PPI-AMO-CLA | - | Treatment like double resistance (#) | |||
Sequential therapy | ◎ | - | - | |||
The doses of PPI, Amoxicillin, Clarithromycin, Metronidazole, and Bismuth are the same as stated above except for esomeprazole or omeprazole (1.5–2.5 mg/kg/d) are also mentioned. | ||||||
TET | 500 mg QID (>12 years old, >40 kg) | |||||
2020 [5] | Japan | PPI-AMO-CLA | PPI-AMO-MET for 7 days | |||
Twice daily | Maximum daily dose (mg/day) | |||||
PPI | ||||||
Lansoprazole | 1.5 mg/kg/day | 60 | ||||
Omeprazole | 1.0 mg/kg/day | 40 | ||||
Rabeprazole | 0.5 mg/kg/day | 20 | ||||
Esomeprazole | ≥4 years old Body weight < 30 kg | 20 mg/day | 40 | |||
Bodyweight ≥ 30 kg | 40 mg/day | |||||
AMO | 50 mg/kg/day | 1500 | ||||
CLA | 15–20 mg/kg/day | 800 | ||||
MET | 10–20 mg/kg/day | 500 |
Study | Region | Study Period | Follow-Up Case Number | Past Treatment Regimen | Treatment | Eradication Rate |
---|---|---|---|---|---|---|
Genis et al., 2013 [47] (abstract) | Belgium | 2007 to 2011 | 25 | Sequential regimen | Tailored triple therapy for 10–14 days | 3/5 (60%) |
Repeated sequential regimen | 13/20 (65%) | |||||
Kallirroi et al., 2019 [48] (abstract) | Belgium | 2011 to 2018 | 52 | Not available | Sequential treatment either a triple therapy (tailored when secondary antimicrobial susceptibility was available) with duration and dosage per local treatment protocols (which were changing over time) | 35/52 (67.3%) |
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Lai, H.-H.; Lai, M.-W. Treatment of Pediatric Helicobacter pylori Infection. Antibiotics 2022, 11, 757. https://doi.org/10.3390/antibiotics11060757
Lai H-H, Lai M-W. Treatment of Pediatric Helicobacter pylori Infection. Antibiotics. 2022; 11(6):757. https://doi.org/10.3390/antibiotics11060757
Chicago/Turabian StyleLai, Hung-Hsiang, and Ming-Wei Lai. 2022. "Treatment of Pediatric Helicobacter pylori Infection" Antibiotics 11, no. 6: 757. https://doi.org/10.3390/antibiotics11060757