Helicobacter pylori eradication in childhood after failure of initial treatment: advantage of quadruple therapy with nifuratel to furazolidone

• Published in: Alimentary pharmacology & therapeutics 2005-11, Vol.22 (9), p.881-887
• Main Authors: NIJEVITCH, A. A., SHCHERBAKOV, P. L., SATAEV, V. U., KHASANOV, R. SH, AL KHASHASH, R., TUYGUNOV, M. M.
• Format: Article
• Language: English
• Subjects: Adolescent; Amoxicillin - adverse effects; Amoxicillin - therapeutic use; Antacids - adverse effects; Antacids - therapeutic use; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Child; Drug Therapy, Combination; Female; Furazolidone - adverse effects; Furazolidone - therapeutic use; Helicobacter Infections - drug therapy; Helicobacter pylori; Helicobacter pylori - drug effects; Humans; Male; Nifuratel - adverse effects; Nifuratel - therapeutic use; Omeprazole - adverse effects; Omeprazole - therapeutic use; Organometallic Compounds - adverse effects; Organometallic Compounds - therapeutic use; Pilot Projects; Prospective Studies; Proton Pump Inhibitors; Treatment Outcome
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.1365-2036.2005.02656.x

Summary Background : Failures of Helicobacter pylori eradication in children are common. Aim : To evaluate the efficacy of amoxicillin, bismuth subcitrate and omeprazole and nifuratel or furazolidone for H. pylori eradication in children who failed initial treatment with a standard triple therapy. Methods : Seventy‐six consecutive H. pylori‐positive paediatric out‐patients (aged 12–16 years; mean age 13.7 ± 1.4) with chronic abdominal complaints who had failed one attempt of eradication of H. pylori using metronidazole‐containing triple therapy were enrolled. It was an open prospective study. Patients were randomized to receive a 2‐week course of bismuth subcitrate (8 mg/kg/day, q.d.s.), amoxicillin (50 mg/kg/day, q.d.s.), with either nifuratel (15 mg/kg/day, q.d.s.) or furazolidone (10 mg/kg/day, q.d.s.), plus omeprazole (0.5 mg/kg, once daily). Results : There were 37 patients in the nifuratel group and 39 in the furazolidone group. Helicobacter pylori was eradicated in 33 of 37 (89%; 95% CI: 74.5–96.9; intention‐to‐treat) in nifuratel group and in 34 of 39 (87%; 95% CI: 72.5–95.7) in furazolidone group, respectively. Frequency of severe side‐effects was greater with furazolidone (21%) than with nifuratel (3%; P = 0.0289). Conclusions : Nitrofuran‐containing therapies consisting of a proton‐pump inhibitor, amoxicillin and bismuth citrate plus either nifuratel or furazolidone produced good cure rates even among those who had failed prior therapy. Nifuratel is preferred because of the lower frequency of side‐effects.