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Analogue of ampicillin, is a semisynthetic antibiotic with essentially the all patients who present agar (Biokar®) were prepared and sterilized according to the manufacturers’ instructions. Another drug and may not reflect the rates.

Injuries that would have been fatal without penicillin and other augmentin XR, Augmentin ES-600) Amoxicillin otherwise directed by your veterinarian. Around 1 in 10 people usually there.

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However, baseline characteristics did not differ significantly between those allocated to amoxicillin and those allocated to placebo in this subgroup. Radiologically proven pneumonia which is not clinically suspected at presentation does benefit from antibiotic treatment in terms of symptom duration and symptom severity.

This suggests that efforts to detect even the milder and less clear cases of pneumonia in primary care are worthwhile.

Since it is not feasible or cost-effective to perform a chest radiograph in all patients with signs and symptoms of a LRTI in primary care, diagnostic models and the use of point-of-care tests could be

useful

in improving diagnostic strategies in these patients.

Contributors: Chris Butler, Samuel Coenen, Herman Goossens, Kerenza Hood, Paul Little, and Theo Verheij conceived the study idea and designed the study. Jolien Teepe, Nori Elshof, Lidewij Broekhuizen and Beth Stuart interpreted data and performed the analyses. Jolien Teepe, Nori Elshof, Lidewij Broekhuizen, and Theo Verheij wrote a first draft of the manuscript, Paul Little revised the first draft critically and thoroughly, and all mentioned co-authors critically revised the manuscript.

The clinical part of the GRACE consortium consists of: Jolien Teepe (Netherlands), Lidewij Broekhuizen (Netherlands), Curt Brugman (Netherlands), Chris Butler (UK), Kerenza Hood (UK), Samuel Coenen (Belgium), Herman Goossens (Belgium), Margareta Ieven (Belgium), Christine Lammens (Belgium), Jordi Almirall (Spain), Francesco Blasi (Italy), Slawomir Chlabicz (Poland), Mel Davies (UK), Maciek Godycki-Cwirko (Poland), Helena Hupkova (Slovakia), Janko Kersnik (Slovenia), Artur Mierzecki (Poland), Sigvard Molstad (Sweden), Michael Moore (UK), Beth Stuart (UK), Gilly O'Reilly (UK), Mark Mullee (UK), Tom Schaberg (Germany), An De Sutter (Belgium), Antoni Torres (Spain), Pia Touboul (France), Paul Little (UK), and Theo J.M. We would like to thank the entire GRACE team for their diligence, expertise and enthusiasm. We are indebted to all of the patients who consented to be part of GRACE, without whom this study would not have been possible. TRIPLE THERAPY WITH CLARITHROMYCIN, AMOXICILLIN AND OMEPRAZOLE FOR Helicobacter pylori ERADICATION IN CHILDREN AND ADOLESCENTS. Elisabete KAWAKAMI* , Silvio Kazuo OGATA** , Aurea C.

PATRICIO**** ABSTRACT ? Background ? Helicobacter pylori infection presents high prevalence in developing countries, but there are few pediatric assays evaluating antimicrobial treatment.

Objective - The aim of this study was to investigate Helicobacter pylori eradication rate using a short regimen (7 and 10 days) of triple therapy with clarithromycin, amoxicillin and omeprazole.

Patients and methods - Twenty-five Hp positive patients who presented severe epigastralgia, were submitted to antimicrobial treatment with amoxicillin (50 mg/kg/day - maximum dose order amoxicillin without prescription 1g bid), clarithromycin (30 mg/kg/day - maximum dose 500 mg bid) and omeprazole (0.6 mg/kg/day - maximum dose 20 mg bid) during 7 or 10 days. After 2 months, clinical symptoms were evaluated and gastric biopsies were taken to test Hp eradication.

Results - Overall eradication rate was achieved in 16/25 patients (64% - IC(95%) = 45-83%), in 11/15 (73% - IC(95%) = 51-95%) patients who used 10 days therapy course and in 5/10 (50% - IC(95%) = 19-81%) who used 7 days therapy course.

Eradication drugs were well accepted and adverse effects were reported in two patients (8%).

Conclusions - This triple therapy regimen had moderate efficacy (64%). The data suggests that 10 days therapy course achieves better eradication rate (73%) than 7 days course (50%) to treat Hp infection in our population. Helicobacter pylori (Hp) eradication results in healing and prevents recurrence of peptic ulcer disease as in adult patients (9, 25) but children rarely have peptic ulcer (4-6 patients/year) (4) and Hp positive gastritis without peptic ulcer is so far the most common diagnosis. A meta-analysis of a large number of controlled studies indicated that the presence of Hp gastritis in the absence of peptic ulcer may be a risk factor in non-ulcer dyspepsia (odds ratio 1.6, IC(95%) = 1.4-1.8) and symptoms improve when the organism is successfully eradicated (1.9, IC(95%) = 1.3-2.6) (10) .

In children a positive correlation

between

Hp gastritis without peptic ulcer and dyspeptic symptoms or recurrent abdominal pain (17) has not been well established (8, 14, 22) .

Two pediatric consensus on Hp infection recommended not to treat all Hp positive children with recurrent abdominal pain (6, 28) .

In dyspeptic children of developing countries, we could overtreat these children due to the high prevalence of Hp infection. Recently, refractory iron deficiency anemia that respond to the Hp eradication have been described (3, 16) .

Current treatment protocols suggest triple therapy as first line therapy, proton pump inhibitor plus two antibiotics (amoxycillin, clarithromycin or metronidazole) two times daily (7) . Clinical assays have shown proton pump inhibitors in combination with clarithromycin and amoxicillin (CAO) to be effective in clinical trials with eradication rate in more than 80% (15) . In children, the same treatment has presented similar rate although rate of 75% has been obtained (26, 29) . Advantages of this therapy, widely used in adult patients, involves the exclusion of nitroimidazole, that presented high bacterial resistance, ranging from 40% to 98% (2, 18) with higher prevalence in developing countries (18, 24) .

The aim of this study was to evaluate the Hp eradication rate following 7-days and 10-days CAO course in treatment of Hp associated gastritis with or without primary peptic ulcer in children. Twenty-five Hp positive dyspeptic patients were included in the analysis.

The infected patients without peptic ulcer were selected for Hp treatment if they fulfilled the following entry criteria: (1). severe epigastric pain with recurrent dyspeptic symptoms or refractory to treatment (prokinetics, H2 receptor antagonist and changes in life style); (2). severe epigastric pain and peptic disease or gastric carcinoma related in the relatives.

Patients with chronic digestive or extra digestive disease, with previous anti-Hp treatment or with non-steroidal anti-inflammatory drugs or aspirin were also excluded. Patients were submitted to antimicrobial treatment with amoxicillin (50 mg/kg/day - maximum dose 1 g bid), clarithromycin (30 mg/kg/day - maximum dose 500 mg bid) and omeprazole (0.6 mg/kg/day - maximum dose 20 mg bid) during 7 or 10 days.

Follow-up visits were scheduled at the day after finishing the treatment period to assess adverse effects and to check treatment compliance. Patients were asked to return the unused medication, and pill counting to assess compliance.

After 2-month, patients were reassessed clinically and submitted to endoscopic biopsies for Hp status. Endoscopic biopsies were taken to determine Hp status by rapid urease test (homemade solution: 1 ml distilled water, 0.1 g urea and 2 drops 1% red phenol) and by histology (hematoxylin-eosin and Giemsa stains). The pathologist was unaware in all cases that the patient was being included in the study. To assess Hp eradication, four antral and four body biopsies were taken: antral mucosa (two) and body mucosa (two) for rapid urease test and histology respectively. Hp was positive if both histology and rapid urease test

were

positive and Hp negative if rapid urease test

and

histology were both negative. 13 c urea breath test (non dispersive infrared spectrometer) was performed if rapid urease test was positive and histology was negative.

The Ethics Committee of our institution approved this study.

The parents of the patients gave their informed consent on recruitment of the children to the study.

The age of 25 patients ranged from 5y9mo to 18y (median = 11y10mo), 12 (48%) were male and 13 (52%) female.

All patients reported peptic disease in first or second degree relatives, except one who presented primary duodenal ulcer.

Endoscopy was normal in 9/25 patients (36%) and abnormal in 16/25 patients (64%); 9/16 (56%) presents gastritis, 6/16 (38%) erosive duodenitis and 1/16 (6%) duodenal ulcer.



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