Assessment of Sequential and Standard Triple Therapy in Treatment of Helicobacter pylori Infection in Children Dependent on Bacteria Sensitivity to Antibiotics

Adv Clin Exp Med. Jul-Aug 2016;25(4):701-8. doi: 10.17219/acem/38554.


Background: In the last decade a 10-day schema of sequential therapy of Helicobacter pylori infection based on proton pomp inhibitor (PPI), amoxicillin (AMO), clarithromycin (CLA) and metronidazole (MET) has been introduced. Many studies have emphasized greater efficacy of this therapy in comparison to the efficacy of the standard 7-day triple therapy (PPI + AMO + CLA or MET).

Objectives: The aim of the study was to assess the sequential and standard triple therapy.

Material and methods: Sixty-nine children, aged 5 to 17 years, with symptoms of dyspepsia and gastric or duodenal ulcer were included in the study. The children were randomly divided into three groups. Group I - 23 children treated with PPI + AMO + CLA, group II - 23 children treated with PPI + AMO + MET, and group III - 23 children treated with sequential therapy. The diagnosis of Helicobacter pylori infection was based on histopathological evaluation of gastric mucosa sample and on culture. The sensitivity of bacterial strains to antibiotics was assessed based on E-tests. The efficacy of Helicobacter pylori eradication was assessed 6-8 weeks after the completion of the treatment.

Results: In children infected with Helicobacter pylori strains, which were sensitive to clarithromycin, the highest rate of eradication was obtained in the group treated with PPI + AMO + CLA (100%) and in the group treated with sequential therapy (90.48%), the lowest was in the group treated with PPI + AMO + MET.

Conclusions: Efficiency of treatment of Helicobacter pylori infection in children depended on sensitivity of the strains to clarithromycin. Sensitivity to metronidazole did not influence significantly the eradication rate.

Keywords: Helicobacter pylori; resistance; sequential therapy; standard triple therapy.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Amoxicillin / administration & dosage*
  • Anti-Infective Agents / administration & dosage
  • Anti-Ulcer Agents / administration & dosage
  • Child
  • Child, Preschool
  • Clarithromycin / administration & dosage*
  • Drug Therapy, Combination
  • Female
  • Helicobacter Infections / drug therapy*
  • Helicobacter pylori
  • Humans
  • Male
  • Metronidazole / administration & dosage*
  • Proton Pump Inhibitors / administration & dosage*


  • Anti-Infective Agents
  • Anti-Ulcer Agents
  • Proton Pump Inhibitors
  • Metronidazole
  • Amoxicillin
  • Clarithromycin