Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov-Dec;29(6):e13149.
doi: 10.1111/hel.13149.

Efficacy of Bismuth Quadruple Therapy in the Treatment of Helicobacter pylori-Infected Peptic Ulcer Children in Vietnam

Thi Minh Phuong Do  1   2 , Thi Huyen Trang Tran  3   4 , Van Tinh Nguyen  2 , Thi Phuong Mai Chu  1   2 , Loi Nguyen  2 , Kim Thanh Nguyen  2 , Thi Bich Ngoc Hoang  5 , Anh Le Huu Phuong  3   4 , Yoshio Yamaoka  6   7   8 , Linus Olson  9   10 , Thi Viet Ha Nguyen  1   2
Affiliations

Efficacy of Bismuth Quadruple Therapy in the Treatment of Helicobacter pylori-Infected Peptic Ulcer Children in Vietnam

Thi Minh Phuong Do et al. Helicobacter. 2024 Nov-Dec.

Abstract

Background: The continuous increase in drug-resistant strains, the lack of novel antibiotics, and the fewer options available to combat antibiotic-resistant infections in pediatrics pose significant challenges to the eradication of Helicobacter pylori (H. pylori) in children. This study evaluated the efficacy of first-line therapy with bismuth quadruple therapy in H. pylori-positive pediatric patients with peptic ulcers.

Materials and methods: 136 patients (aged between 8 and 17 years) diagnosed with active peptic ulcers with H. pylori infection were enrolled in this study. Patients with H. pylori strain sensitive to tetracycline and metronidazole were assigned to bismuth quadruple therapy, including a proton pump inhibitor (PPI), bismuth, tetracycline, and metronidazole. Antibiotic resistance of H. pylori was analyzed by the Epsilometer test. Treatment efficacy was evaluated at 12 weeks based on H. pylori eradication and peptic ulcer healing rates. H. pylori infection status was evaluated by a 13C-urea breath test.

Results: Most isolates showed extremely high rates of resistance to commonly prescribed antibiotics used for children, including clarithromycin (97.0%) and amoxicillin (84.6%), while the low rate of resistance to levofloxacin (16.2%). The overall success rate of eradication therapy in the intention-to-treat and the per-protocol group were 86.0% and 89.3%, respectively. Peptic ulcer healing rates for total patients at 6 weeks and 12 weeks were 75.0% and 97.7%, respectively. There were no entail unpleasant adverse events, and peptic ulcer symptoms decreased steadily over time in all cases.

Conclusions: The bismuth quadruple therapy with a 2-week PPI pretreatment and followed by prolonged PPI was highly successful in eradicating H. pylori infection and healing ulcers in pediatric patients with active peptic ulcer. This might be preferable as a first-line empiric treatment regimen for H. pylori-positive pediatric patients with peptic ulcers, especially in populations with high rates of resistance to amoxicillin and clarithromycin.

Keywords: Helicobacter pylori eradication; antibiotic resistance; bismuth quadruple therapy; children; peptic ulcers.

PubMed Disclaimer

References

    1. X. Xie, K. Ren, Z. Zhou, C. Dang, and H. Zhang, “The Global, Regional and National Burden of Peptic Ulcer Disease From 1990 to 2019: A Population‐Based Study,” BMC Gastroenterology 22, no. 1 (2022): 58, https://doi.org/10.1186/s12876‐022‐02130‐2.
    1. G. Guariso and M. Gasparetto, “Update on Peptic Ulcers in the Pediatric Age,” Ulcers 2012 (2012): 1–9, https://doi.org/10.1155/2012/896509.
    1. A. Lanas and F. K. L. Chan, “Peptic ulcer disease,” Lancet 390, no. 10094 (2017): 613–624, https://doi.org/10.1016/S0140‐6736(16)32404‐7.
    1. M. Homan, N. L. Jones, P. Bontems, et al., “Updated Joint ESPGHAN/NASPGHAN Guidelines for Management of Helicobacter pylori Infection in Children and Adolescents (2023),” Journal of Pediatric Gastroenterology and Nutrition 79 (2024): 758–785, https://doi.org/10.1002/jpn3.12314.
    1. P. Malfertheiner, F. Megraud, T. Rokkas, et al., “Management of Helicobacter pylori Infection: The Maastricht VI/Florence Consensus Report,” Gut 71, no. 9 (2022): 1724–1762, https://doi.org/10.1136/gutjnl‐2022‐327745.

LinkOut - more resources