Oderda G et al. (2004) Dual vs triple therapy for childhood Helicobacter pylori gastritis: a double-blind randomized multicentre trial. Helicobacter 9: 293–301

Responding to a lack of data on Helicobacter pylori eradication in children, Oderda and colleagues have carried out a multicenter trial to compare the efficacy of two approaches.

Forty three children undergoing endoscopy for upper gastrointestinal dyspepsia with H. pylori gastritis were randomized to triple therapy (lansoprazole plus amoxicillin and tinidazole) or dual therapy (placebo plus amoxicillin and tinidazole) for 1 week. The children were assessed using 13C-urea breath tests and 2-week symptom diary cards up to 6 months after treatment. A structured questionnaire was completed 1–2 years after the end of the trial for 36 of the children. The study aimed to compare the efficacy of the two treatments in terms of H. pylori eradication and, as a secondary endpoint, to examine the effect of treatment on long-term reduction of dyspeptic symptoms.

Six weeks after treatment, there was no significant difference between the rates of H. pylori eradication in the triple therapy group (68.2%) and the dual therapy group (71%). Similar rates were shown at 6 months. Dyspeptic symptoms had either disappeared or were reduced in most children at 6 weeks and 6 months, whether or not H. pylori had been eradicated. Longer term follow-up, however, revealed that epigastric pain had recurred in most of the H. pylori-positive children.

The authors suggest that tailoring the treatment according to the antibiotic resistance of the strain would help to increase eradication rates and this, in turn, should improve long-term resolution of symptoms.