A systematic review of Helicobacter pylori eradication treatment schedulesin children

Methods: We systematically reviewed all available data in the paediatric li terature on treatment for Helicobacter pylori infection to determine overal l efficacy of different schedules. A comprehensive search of all published articles and letters from 1987, and of abstracts presented at three main me etings on this topic between 1997 and 1999, was carried out. Results from a ll English and French papers, letters and abstracts were extracted and anal ysed. Results: Only 30 full articles and 16 abstracts were found, with results on eradication of H. pylori in 870 and 1552 children, respectively. Monothera py or dual therapy with an antisecretory drug plus one antibiotic showed a very low efficacy. Dual therapies with bismuth plus one antibiotic (either amoxycillin or a nitroimidazole) or two antibiotics when administered for 2 or more weeks were as effective as either bismuth-based or proton pump inh ibitor-based triple therapies. Triple therapies were less effective than in adults, and while bismuth-based triple therapies were more effective when given for 2 weeks than for one week, proton pump inhibitor-based triple the rapies have a similar efficacy irrespective of the duration. Conclusion: In children dual therapies seemed as effective as triple therap ies, and longer courses of proton pump inhibitor-base triple therapies are not better than shorter ones.