Journal article

Publication year: 2023

Pages: 921-934

Journal: Infection

Volume number: 51

Issue number: 4

DOI Link: https://doi.org/10.1007/s15010-022-01948-y

Publisher: Springer

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.

Harvard Citation style: Le Thi, T., Werkstetter, K., Kotilea, K., Bontems, P., Cabral, J., Cilleruelo Pascual, M., et al. (2023) Management of Helicobacter pylori infection in paediatric patients in Europe: results from the EuroPedHp Registry, Infection, 51(4), pp. 921-934. https://doi.org/10.1007/s15010-022-01948-y

APA Citation style: Le Thi, T., Werkstetter, K., Kotilea, K., Bontems, P., Cabral, J., Cilleruelo Pascual, M., Kori, M., Barrio, J., Homan, M., Kalach, N., Lima, R., Tavares, M., Urruzuno, P., Misak, Z., Urbonas, V., Koletzko, S., & Helicobacter pylori Special Interest Group of ESPGHAN (2023). Management of Helicobacter pylori infection in paediatric patients in Europe: results from the EuroPedHp Registry. Infection. 51(4), 921-934. https://doi.org/10.1007/s15010-022-01948-y