نبذة مختصرة : Aim: The aim of the study was to find the optimal H. pylori eradication therapy for children in Vietnam, a developing country. Therefore, we evaluated a non-invasive diagnostic method and antibiotic susceptibility of H. pylori strains, the major determinant of treatment outcome, as well as the rate of reinfection after successful eradication, a determinant for the rational of H. pylori eradication. Materials: In a treatment trial, gastric biopsy, blood and faecal samples were obtained from 240 children (age 3-15 years) for various gastrointestinal complaints. H. pylori infection status was based on either positive culture or positive monoclonal antigen-in-stool test (Premier Platinum HpSA PLUS) at inclusion and positive monoclonal antigen-in-stool test after treatment and during one year of follow up. For evaluation of specificity of monoclonal antigen-in-stool test, blood and faecal samples from 241 children of similar age with non-gastrointestinal conditions were included. Methods: In a prospective randomized double-blind treatment trial, children received a combination of lansoprazole and amoxicillin with either clarithromycin (LAC) or metronidazole (LAM). The antigen-in-stool test was used to determine H. pylori status in the treatment trial and in the reinfection study. Culture of H. pylori from biopsies was performed by standard methods. Susceptibility testing of H. pylori to all three antibiotics was performed by E-test using microaerophilic incubation for ≥72h at 35oC. Results: The sensitivity of Premier Platinum HpSA PLUS was 96.6% (95% CI 93.3-98.5) and the specificity was 94.9% (95% CI 88.5-98.3). The per protocol eradication rate was similar in the two treatment regimens, 62.1% for the LAM and 54.7% for the LAC regimens, respectively. The overall resistance to clarithromycin, metronidazole and amoxicillin was 50.9%, 65.3% and 0.5%, respectively. In LAC regimen, eradication was linked to the strains being sensitive (OR 7.23, 95% CI 2.10-24.9, relative to resistant strains). Twice-daily dosage was more ...
Relation: I. Nguyen TV, Bengtsson C, Nguyen GK, Granström M (2008). Evaluation of a novel monoclonal-based antigen-in-stool enzyme immunoassay (Premier Platinum HpSA PLUS) for diagnosis of Helicobacter pylori infection in Vietnamese children. Helicobacter. 13(4): 269-73. ::pmid::18665935; II. Nguyen TV, Bengtsson C, Nguyen GK, Hoang TT, Phung DC, Sörberg M, Granström M (2008). Evaluation of two triple-therapy regimens with metronidazole or clarithromycin for the eradication of H. pylori infection in Vietnamese children: a randomized, double-blind clinical trial. Helicobacter. 13(6): 550-6. ::pmid::19166421; III. Nguyen TV, Bengtsson C, Yin L, Nguyen GK, Hoang TTH, Phung DC, Sörberg M, Granström M (2009). Eradication of Helicobacter pylori infection in Vietnamese children in relation to antibiotic resistance. [Submitted]; IV. Nguyen TV, Bengtsson C, Nguyen GK, Yin L, Hoang TTH, Phung DC, Sörberg M, Granström M (2009). Age as risk factor for Helicobacter pylori reinfection in Vietnamese children. [Submitted]; 20091211nguy; http://hdl.handle.net/10616/38104
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