The effectiveness of various eradication schemes for Helicobacter pylori in adults has been widely studied, including through a series of meta-analyzes, while no similar study has been conducted. for kids. The goal of a systematic study and meta-analysis by R. Khurana et al. (USA), was to summarize the data on the efficacy of different eradication regimes for H. pylori in children and identify the causes of possible variations in efficacy in various studies. The authors of the work carried out a search in the Medline databases, references on relevant subjects and conference documents, following which 80 studies were selected for the final analysis (127 comparison modes), including 4436 children. In general, the methodological quality of the included work was low and the sample size was small. Only a small number of studies have been randomized and controlled.

According to the results, the use of a drug for the eradication of H. pylori in children was ineffective and, therefore, should not be practiced. The highest efficacy (eradication rate of more than 80%) has been shown for a treatment of 2 weeks with a combination of nitroimidazole and amoxicillin in Europe (n = 213), a combination of bismuth, amoxicillin and metronidazole in developing countries, except Latin America (n = 73), a combination of macrolide, nitroimidazole and a proton pump inhibitor in Canada, the United States and in Israel (n = 49) and a one to two week treatment with a combination of clarithromycin, amoxicillin and a proton pump inhibitor in Europe and China (n = 701).

The main factors that influenced the effectiveness of the eradication treatment were the choice of drugs, the duration of their use, the methods of evaluating the efficacy of the treatment and the geographical region where the study was conducted. The influence of geographic location on the effectiveness of eradication therapy has been observed in most studies, which, according to the authors, is associated with differences in antibiotic resistance levels of H. pylori in different regions of the world.

As the authors conclude, before developing global recommendations for the choice of H. pylori eradication in children, additional randomized placebo-controlled studies are needed, particularly in countries in development, where the frequency of infection by this microorganism and its level are high resistance to antibacterial drugs.