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- Title
Management of Helicobacter pylori infection in paediatric patients in Europe: results from the EuroPedHp Registry.
- Authors
Le Thi, Thu Giang; Werkstetter, Katharina; Kotilea, Kallirroi; Bontems, Patrick; Cabral, José; Cilleruelo Pascual, Maria Luz; Kori, Michal; Barrio, Josefa; Homan, Matjaž; Kalach, Nicolas; Lima, Rosa; Tavares, Marta; Urruzuno, Pedro; Misak, Zrinjka; Urbonas, Vaidotas; Koletzko, Sibylle; for the Helicobacter pylori Special Interest Group of ESPGHAN; Sykora, Josef; Miele, Erasmo; Krahl, Andreas
- Abstract
Purpose: The EuroPedHp-registry aims to monitor guideline-conform management, antibiotic resistance, and eradication success of 2-week triple therapy tailored to antibiotic susceptibility (TTT) in Helicobacter pylori-infected children. Methods: From 2017 to 2020, 30 centres from 17 European countries reported anonymized demographic, clinical, antibiotic susceptibility, treatment, and follow-up data. Multivariable logistic regression identified factors associated with treatment failure. Results: Of 1605 patients, 873 had follow-up data (53.2% female, median age 13.0 years, 7.5% with ulcer), thereof 741 (85%) treatment naïve (group A) and 132 (15%) after failed therapy (group B). Resistance to metronidazole was present in 21% (A: 17.7%, B: 40.2%), clarithromycin in 28.8% (A: 25%, B: 51.4%), and both in 7.1% (A: 3.8%, B: 26.5%). The majority received 2-week tailored triple therapy combining proton pump inhibitor (PPI), amoxicillin with clarithromycin (PAC) or metronidazole (PAM). Dosing was lower than recommended for PPI (A: 49%, B: 41%) and amoxicillin (A: 6%, B: 56%). In treatment naïve patients, eradication reached 90% (n = 503, 95% CI 87–93%) and 93% in compliant children (n = 447, 95% CI 90–95%). Tailored triple therapy cured 59% patients after failed therapy (n = 69, 95% CI 48–71%). Treatment failure was associated with PAM in single clarithromycin resistance (OR = 2.47, 95% CI 1.10–5.53), with PAC in single metronidazole resistance (OR = 3.44, 95% CI 1.47–8.08), and with low compliance (OR = 5.89, 95% CI 2.49–13.95). Conclusions: Guideline-conform 2-weeks therapy with PPI, amoxicillin, clarithromycin or metronidazole tailored to antibiotic susceptibility achieves primary eradication of ≥ 90%. Higher failure rates in single-resistant strains despite tailored treatment indicate missed resistance by sampling error.
- Subjects
EUROPE; REPORTING of diseases; HELICOBACTER pylori; COMBINATION drug therapy; BISMUTH; CONFIDENCE intervals; DISEASE eradication; CLARITHROMYCIN; MEDICAL protocols; TREATMENT effectiveness; NATIONAL health services; METRONIDAZOLE; PROTON pump inhibitors; TREATMENT failure; RESEARCH funding; DESCRIPTIVE statistics; DRUG resistance in microorganisms; LOGISTIC regression analysis; ODDS ratio; PATIENT compliance; HELICOBACTER diseases; AMOXICILLIN; EVALUATION
- Publication
Infection, 2023, Vol 51, Issue 4, p921
- ISSN
0300-8126
- Publication type
Article
- DOI
10.1007/s15010-022-01948-y