SEARCHCOHORTpediatrics, gastroenterology

cohort·pediatrics, gastroenterology, infectious disease, clinical trial, observational study·PMC10352155

Management of Helicobacter pylori infection in paediatric patients in Europe: results from the EuroPedHp Registry

Infection · 32 authors, 14 centres

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FIDELITY 100%

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AGENT 01 · STRUCTURED SUMMARY

TRACE TO SOURCE

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TL;DR

Resistance to clarithromycin and metronidazole was more frequent in previously treated patients.

Full summary

829 CHARS

Patients received 2-week tailored triple therapy (PPI plus amoxicillin with clarithromycin or metronidazole) based on antibiotic susceptibility testing. In 741 treatment-naïve patients, eradication reached 90% (95% CI 87–93%), rising to 93% in compliant children. Tailored triple therapy cured only 59% of 132 patients after prior failed therapy. Risk factors for treatment failure included use of PAM when clarithromycin resistance was present (OR 2.47) and PAC when metronidazole resistance was present (OR 3.44), suggesting sampling error missed resistance. Low compliance was strongly associated with failure (OR 5.89). Limitations include reliance on parental-reported compliance and prior treatment history, loss to follow-up in one-third of patients, and locally performed (rather than centralised) susceptibility testing.

STUDY TYPE

cohort

SPECIALTY

pediatrics

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10352155

Management of Helicobacter pylori infection in paediatric patients in Europe: results from the EuroPedHp Registry

Infection

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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. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-022-01948-y.

CITATION EXPORT

Thu Giang Le Thi, Katharina Werkstetter, Kallirroi Kotilea et al.. Management of Helicobacter pylori infection in paediatric patients in Europe: results from the EuroPedHp Registry. Infection. (2022). https://doi.org/10.1007/s15010-022-01948-y

AUTHORS

32 · 14 CENTRES

Thu Giang Le Thi, Katharina Werkstetter, Kallirroi Kotilea, Patrick Bontems, José Cabral, Maria Luz Cilleruelo Pascual, Michal Kori, Josefa Barrio, Matjaž Homan, Nicolas Kalach, Rosa Lima, Marta Tavares, Pedro Urruzuno, Zrinjka Misak, Vaidotas Urbonas, Sibylle Koletzko, Josef Sykora, Erasmo Miele, Andreas Krahl, Martina Klemenak, Alexandra Papadopoulou, Andrea Chiaro, Meltem Korkut Ugras, Jan de Laffolie, Krzysztof Matusiewics, Francesca Rea, Thomas Casswall, Eleftheria Roma, Hany Banoub, Aron Cseh, Maria Rogalidou, Ana Isabel Lopes

1grid.5252.00000 0004 1936 973XDr. von Hauner Children’s Hospital, University Hospital, LMU Munich, Lindwurmstrasse 4, 80337 Munich, Germany
2grid.412209.c0000 0004 0578 1002Université Libre de Bruxelles, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
3grid.414034.60000 0004 0631 4481Pediatric Gastroenterology Unit, Dona Estefânia Hospital, University Hospital Centre of Central Lisbon, Lisbon, Portugal
4grid.73221.350000 0004 1767 8416Pediatrics Department, Gastroenterology Unit, University Hospital Puerta de Hierro Majadahonda, Madrid, Spain
5Pediatric Gastroenterology, Kaplan Medical Centre, Rehovot, Israel
6grid.9619.70000 0004 1937 0538Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
7grid.411242.00000 0000 8968 2642Department of Paediatrics, Hospital Universitario de Fuenlabrada, Madrid, Spain
8grid.29524.380000 0004 0571 7705Department of Gastroenterology, Hepatology, and Nutrition, Faculty of Medicine, University Children’s Hospital, University of Ljubljana, Ljubljana, Slovenia
9grid.488857.e0000 0000 9207 9326Groupement des Hôpitaux de l’Institut Catholique de Lille (GHICL), Saint Antoine Paediatric Clinic, Saint Vincent de Paul Hospital, Catholic University, Lille, France
10grid.5808.50000 0001 1503 7226Division of Paediatrics, Paediatric Gastroenterology Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
11grid.144756.50000 0001 1945 5329Pediatric Gastroenterology Unit, Hospital 12 de Octubre, Madrid, Spain
12grid.414193.a0000 0004 0391 6946Referral Centre for Paediatric Gastroenterology and Nutrition, Children’s Hospital Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
13grid.6441.70000 0001 2243 2806Clinic of Children’s Diseases of Vilnius University Faculty of Medicine, Vilnius, Lithuania
14grid.412607.60000 0001 2149 6795Department of Paediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum University of Warmia and Mazury, Olsztyn, Poland