Efficacy of a novel sequential treatment regimen containing bismuth forHelicobacter pylorieradication in Turkish children

Background Eradication rates ofHelicobacter pylori(H pylori) with standard triple therapy are gradually decreasing all over the world, including in children, due to the development of strains resistant to antimicrobials. Sequential therapy can be used as an alternative method to increase eradication rates. Materials and Methods A total of 75 patients >= 8 years of age withH pylorigastritis were included in the study. According to Rome IV criteria, 38 patients had functional abdominal pain and dyspepsia, and 37 patients had alarm findings suggesting organic disease. Patients were treated with a novel sequential therapy consisting of the proton pump inhibitor (PPI)-lansoprazole (1 mg/kg/day, maximum 30 mg daily), amoxicillin (50 mg/kg/d in two doses, maximum 2 x 1000 mg) for 7 days followed by PPI-lansoprazole (1 mg/kg/d, maximum 30 mg daily), metronidazole (20 mg/kg/day in two doses, maximum 2 x 500 mg), tetracycline (50 mg/kg/d divided into four equal doses, maximum 4 x 500 mg), and bismuth subsalicylate (262 mg QID in patients <= 10 years of age, 524 mg QID in patients > 10 years of age in days 8-14). Eradication status was evaluated byH pyloristool antigen test 8 weeks after the completion of treatment. Results The mean age of the patients was 15.1 +/- 2.4 years and 51 (68%) were female. No patient discontinued therapy due to side effects. All patients had antral gastritis (76.0%) or pangastritis (24.0%). The peptic ulcer rate was 6.6%. Eradication therapy was given to all patients with or without peptic ulcer.H pylorieradication was achieved in 69 (92.0%) patients and symptoms improved in 61 of those eradicated. Conclusions As a first-line treatment forH pylorieradication in children, administering a novel sequential therapy including bismuth for 14 days provides a high rate of eradication.