What is the efficacy of triple therapies for treatment of H pylori chronic gastritis, and what are adverse effects?

Updated: Jun 07, 2019
  • Author: Akiva J Marcus, MD, PhD; Chief Editor: BS Anand, MD  more...
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Answer

In a study of triple therapy with lansoprazole 0.75 mg/kg plus amoxicillin 25 mg/kg plus clarithromycin 10 mg/kg given twice daily for 7 days, the eradication rate was 87%. A similar study used the same drugs but different dosages—lansoprazole 0.45 mg/kg/day in 2 doses (maximum dose, 15 mg twice daily), amoxicillin 40 mg/kg/day in 2 doses (maximum dose, 1 g twice daily), and clarithromycin 250 mg (for age < 10 y) or 500 mg (for age >10 y) twice daily for 2 weeks. This protocol eradicated bacteria in only 56% of children.

Eradication rates in children have been reported to be as high as 96% with alternative eradication regimens that include amoxicillin, bismuth, and metronidazole.

The adverse effects of the various regimens are similar in children and adults. Bismuth toxicity is not a concern in children receiving H pylori therapy, but salicylate toxicity from the use of bismuth subsalicylate is. Inform parents of the presence of subsalicylate. Ideally, children younger than 16 years should not receive salicylate-containing compounds, because of the risk of Reye syndrome.


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