Treatment of helicobacter pylori [h. pylori] infection in children: a prospective study comparing two different therapeutic regimens

During a period of 10 months from May to February 1995, 120 children [72 girls, 48 boys] with an age range of 4-16 years [mean age 10.87, S.D +/- 2.7] with chronic abdominal pain who had an abnormal endoscopy [gastroduodenal mucosal defect] and positive urease test were treated for H. pylori. Patients were treated randomly with either metronidazole and amoxicillin [double therapy, group A] or metronidazole, amoxicillin and bismuth subsalicylate [triple therapy, group B], each for two weeks. 6-8 weeks after completion of treatment, patients were reevaluated by endoscopy and urease test. Endoscopy was normal in 75 cases [63%]. Of the 45 cases with abnormal endoscopy, 37 patients [82%] were in group A and 8 patients [18%] in group B [p<0.001]. The urease test was positive in 44 cases [70%] of group A and 12 cases [20%] of group B [p<0.001]. It is concluded that double therapy is relatively ineffective in eradication of H. pylori and triple therapy is less effective in this area compared with reports from industrialized countries. This difference is most probably due to greater drug resistance in this part of the world