J Korean Med Sci 2006; 21: 1037-40 ISSN 1011-8934 Copyright The Korean Academy of Medical Sciences Efficacy of Two Triple Eradication Regimens in Children with Helicobacter pylori Infection Triple therapy with bismuth subsalicylate, amoxicillin, metronidazole (BAM) or with omeprazole, amoxicillin, clarithromycin (OAC) has been commonly used for the era- dication of Helicobacter pylori infection. We compared the efficacy of these triple therapies in children with H. pylori infection. We retrospectively analyzed results in 233 children with H. pylori infection and treated with OAC (n=141) or BAM (n=92). Overall eradication rates of triple therapy with OAC and BAM were 74% and 85%, respectively, which showed no statistical difference. Our study showed that the triple therapy with BAM was more effective for the first-line eradication of H. pylori infec- tion in Korean children, but has no statistical difference with OAC regimen. Jungi Choi, Joo Young Jang, Joon Sung Kim, Hwa Young Park*, Yon Ho Choe , Kyung Mo Kim Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul; Department of Pediatrics*, Eulji University School of Medicine, Seoul; Department of Pediatrics , Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Received : 1 February 2006 Accepted : 24 May 2006 Address for correspondence Kyung Mo Kim, M.D. Department of Pediatrics, Asan Medical Center, University of Ulsan, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Korea Tel : +82.2-3010-3380, Fax : +82.2-473-3725 E-mail : kmkim@amc.seoul.kr *This study was supported by a Grant from Asan Insti- tute of Life Science (2004-173). Key Words : Helicobacter pylori, Treatment Outcome, Child; bismuth subsalicylate; Amoxicillin; Metronidazole INTRODUCTION Helicobacter pylori (H. pylori) is a spiral-shaped, Gram-nega- tive bacillus first isolated in 1983 (1). H. pylori is the major pathogen of chronic gastritis and peptic ulcer disease and is strongly associated with gastric adenocarcinoma and lym- phoma (2, 3). Triple therapy with two antibiotics and a pro- ton pump inhibitor (PPI) has been recommended as the treat- ment of choice for H. pylori infection (4, 5), producing an era- dication rate of 70-80% in adults, but there have been few large-scale trials of the efficacy of PPI-based triple eradication therapy in children. In addition, H. pylori has shown antimi- crobial resistance, which may be the cause of treatment fail- ure in many patients (6-8). The aim of this study was to com- pare the efficacy in pediatric patients of two triple eradica- tion therapies commonly used in Korea. MATERIALS AND METHODS Patients This is a retrospective study of 233 pediatric patients with H. pylori infection at two tertiary general hospitals (Asan Med- 1037 ical Center and Samsung Medical Center) between January 1999 and July 2004. Patients were excluded if they had un- dergone previous treatment for H. pylori or if they had taken any antibiotics or PPI in the 4 weeks prior to the study. Eso- phagogastroduodenoscopy was performed in each patient prior to treatment since all patients had suffered from dyspepsia or upper abdominal pain suggestive of an organic disease. H. pylori infection was diagnosed when both histology and a rapid urease test showed positive result. Methods While 141 of 233 children were initially treated with an OAC regimen, and 92 of 233 children were initially treated with a BAM regimen. Details of regimens were described in Table 1. Definition of eradication Efficacy was evaluated 12 weeks after the end of treatment using a 13C-urea breath test (UBT), performed according to a previously validated technique. Briefly, after a fasting base- line sample breath collection, 13C-labelled urea was admin- istered orally in water, and a second breath sample was col-