Comparative Efficacy and Safety of Triple vs. Bismuth Quadruple Therapy in Pediatric H. pylori

Overview

This retrospective cohort study compared 14-day triple therapy and bismuth-containing quadruple therapy in 161 children with H. pylori infection. The quadruple therapy demonstrated significantly higher eradication rates and greater symptom improvement without increased adverse events or reduced compliance.

Background

Helicobacter pylori infection is common in children and can cause chronic gastritis and peptic ulcers, impacting growth and quality of life. Standard triple therapy with a proton pump inhibitor, clarithromycin, and amoxicillin faces challenges due to rising antibiotic resistance. Bismuth-containing quadruple therapy adds bismuth, which has antimicrobial effects that may enhance eradication and overcome resistance. Pediatric-specific data comparing these regimens are limited, necessitating studies to guide optimal treatment choices.

Data Highlights

Key Findings

• Bismuth-containing quadruple therapy achieved a significantly higher H. pylori eradication rate (90.36%) compared to triple therapy (74.36%).
• Post-treatment symptom scores for abdominal pain, bloating, and nausea improved more with quadruple therapy.
• In patients with successful eradication, quadruple therapy still resulted in lower abdominal pain scores, suggesting bismuth's independent symptom relief effect.
• Adverse event rates and medication adherence were similar between the two treatment groups.
• Multivariate analysis identified quadruple therapy as a protective factor against eradication failure (Adjusted OR = 0.351, P = 0.018).

Clinical Implications

Bismuth-containing quadruple therapy should be considered a preferred first-line treatment for pediatric H. pylori infection due to its superior eradication efficacy and symptom relief without compromising safety or adherence. Clinicians can confidently prescribe this regimen to improve outcomes in children, especially in regions with high antibiotic resistance.

Conclusion

Bismuth-containing quadruple therapy offers significant advantages over standard triple therapy in eradicating H. pylori and alleviating gastrointestinal symptoms in children, maintaining a comparable safety and compliance profile. This supports its use as an effective pediatric treatment strategy.

Related Resources & Content

1. Study Authors/People's Hospital of Cangnan/2024 -- Comparative Analysis of Eradication Success, Side Effects, and Adherence in Pediatric Patients Treated with Triple Therapy Versus Bismuth-Containing Quadruple Therapy for Helicobacter pylori Infection