Review Article: Bismuth-based Therapy for Helicobacter Pylori Eradication in Children

L. Pacifico*, J. F. Osborn†, C. Anania*, D. Vaira‡, E. Olivero* & C. Chiesa§


Aliment Pharmacol Ther. 2012;35(9):1010-1026. 

In This Article


The success of eradication therapy for H. pylori has been declining, and recent studies performed in the United States and Europe have shown that the eradication rate has dropped below the 85% threshold that most consensus guidelines recommend.[10] For these reasons, recent paediatric guidelines recommend bismuth-based triple therapy as alternate first-line therapy, and bismuth-based quadruple therapy as second line or salvage therapy. However, most evidence and recommendations have been derived from adult data and the majority of paediatric studies have come from single-centre case series and reports that include relatively small numbers of patients. Although the few triple therapy comparative studies seem to indicate that the use of bismuth compounds may slightly increase the H. pylori eradication rate, case series do not report rates that are particularly high – certainly not of the order of 95%. The evidence in favour of bismuth compounds for treating infected children is still not clear. Thus, well-designed, randomised, multi-centre studies of H. pylori eradication trials in children comparing bismuth-based triple therapy with the best available recommended first-line therapies may be needed to further ensure proper use of primary bismuth-based therapy in children with H. pylori infection. The evidence obtained from audited case series that produce an eradication rate of > 95% on per protocol analysis should also be considered. It is also noteworthy that the potential toxicity of bismuth-containing compounds has resulted in the ban or restriction of their use in some countries.


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