ONE-WEEK TRIPLE THERAPY WITH OMEPRAZOLE, CLARITHROMYCIN, AND NITROIMIDAZOLE FOR HELICOBACTER-PYLORI INFECTION IN CHILDREN AND ADOLESCENTS

Background. Resolution of Helicobacter pylori infection is important i n the management of peptic ulcer disease and reduces peptic ulcer recu rrence in both adults and children. Various anti-H pylori treatment re gimens have been proposed, reflecting the incomplete clinical success of each. A combination of omeprazole, clarithromycin, and tinidazole, given for 1 week, has been shown to be highly tolerable and effective, achieving a success rate of >90% in the adult population. Objective. The aim of this study was to evaluate this short-term regimen in pedia tric and adolescent populations. Methods. The study group consisted of (sic) children referred for evaluation of dyspeptic symptoms. They al l underwent upper gastrointestinal endoscopy, in which H pylori infect ion was confirmed by rapid urease test and/or histologic staining. The y were given omeprazole (20 mg twice daily), clarithromycin (250 mg tw ice daily), and tinidazole or metronidazole (500 mg twice daily) for 1 week. The patients were divided into two groups: those who received t he first course of anti-a pylori therapy during this study (group 1) a nd those who had previously received standard metronidazole and bismut h combination therapies that failed to eradicate H pylori (group 2). T herapeutic efficacy was assessed by a C-13-urea breath test performed 4 weeks after completion of treatment. Results. The 35 study patients had a mean age of 15.9 years (range, 10 to 19) and included 19 males a nd 16 females, of whom 22 were born in Israel. and 13 were immigrants from the former USSR There were 27 patients (77.1%) in group 1 and 8 p atients (22.9%) in group 2. Endoscopic findings were nodular gastritis (14), gastritis (11), gastric ulcer (1), duodenal ulcer (5), and duod enitis (4). H pylori resolution was significantly higher in group 1 pa tients (24/27, 88.9%) than in group 2 patients (1/8, 12.5%). There was no difference between patients with nodular gastritis and those with nonnodular gastritis, and between Israeli-born patients and patients b orn in the former USSR. Compliance in both groups was equally good, an d no major side effects were recorded. Conclusions. One-week omeprazol e/clarithromycin/tinidazole triple therapy is highly tolerable and eff ective for treating H pylori in the pediatric age group, but previous treatment failure diminishes the likelihood of success with this regim en.