Treatment of Helicobacter pylori infection in children: A systematic review

Table 4 Summary of therapeutic schemes used in included studies

Ref.	Treatment schemes
Moubri et al[22]	Group A - Amoxicillin-based triple therapy: (1) Children > 30 kg: Omeprazole 40 mg/d, amoxicillin 50 mg/kg/d with a maximum of 2 g/d and clarithromycin 15 mg/kg/d for 7 d. All given in two daily doses; and (2) Children < 30 kg: omeprazole 2 × 10 mg/d b.i.d., amoxicillin 50 mg/kg/d b.i.d. with a maximum of 2 g/d, and clarithromycin 15 mg/kg/d b.i.d. for 7 d.
	Group B - Metronidazole-based triple therapy: (1) Children > 30 kg: Omeprazole 2 × 20 mg/d, amoxicillin 50 mg/kg/d b.i.d. with a maximum of 2 g/d and metronidazole 40 mg/kg/d b.i.d. for 10 d; and (2) Children < 30 kg: omeprazole 2 × 10 mg/d, amoxicillin 50 mg/kg/d b.i.d. with a maximum of 2 g/d and metronidazole 40 mg/kg/d b.i.d., for 10 d, with a maximum of 1.5 g/d in children above 30 kg and 1 g/d in children below 30 kg body weight.
Namkin et al[23]	Probiotic group: Yomogi® 250 mg lyophilizate - 1 capsule daily for 30 d.
	Placebo group: placebo capsule 250 mg - lactose and powdered wheat starch - 1 capsule daily for 30 d.
Akcam et al[24]	Standard triple therapy group: Omeprazole 1 mg/kg, before breakfast, amoxicillin 50 mg/kg b.i.d. after meals, clarithromycin 15 mg/kg b.i.d. after meals for 7 d.
	Standard triple therapy group + probiotics: Omeprazole 1 mg/kg, before breakfast + amoxicillin 50 mg/kg b.i.d. after meals, clarithromycin 15 mg/kg b.i.d. after meals, PROBINUL® 5 g once a day for 7 d.
Tolone et al[25]	Standard triple therapy group - lansoprazole 30 mg, before breakfast, amoxicillin 50 mg/kg/d b.i.d., clarithromycin 15 mg/kg/d b.i.d. for 14 d.
	Standard triple therapy group + probiotics: Lansoprazol 30 mg, before breakfast + amoxicillin 50 mg/kg/d b.i.d., clarithromycin 15 mg/kg/d b.i.d., Maflor® plus 1 capsule, b.i.d. for 14 d.
Farahmand et al[26]	Group A - Ciprofloxacin-based triple therapy: Ciprofloxacin 30 mg/kg/d b.i.d. and amoxicillin 50 mg/kg/d b.i.d. for 1 wk. Omeprazole 1 mg/kg/d b.i.d for 4 wk.
	Group B - Furazolidone-based triple therapy: furazolidone 6 mg/kg/d single-dose over and amoxicillin 50 mg/kg/d b.i.d. for 1 wk. omeprazole 1 mg/kg/d b.i.d. for 4 wk.
Ahmad et al[27]	Group A - Triple therapy + placebo: Amoxicillin 50 mg/kg/d b.i.d., as syrup or capsule, and furazolidone 6 mg/kg/d b.i.d. as syrup or tablet for 1 wk. Omeprazole 1 mg/kg/d plus placebo for 4 wk.
	Group B - Triple therapy + probiotics: Amoxicillin 50 mg/kg/d b.i.d., as syrup or capsule, and furazolidone 6 mg/kg/d b.i.d. as syrup or tablet, for 1 wk. Omeprazole 1 mg/kg/d plus placebo for 1 sachet/d for 4 wk.
Bin et al[28]	Group A - Triple therapy + Saccharomyces boulardii: Amoxicillin, omeprazole, clarithromycin and 2 sachet S. boulardii 250 mg per day, for 2 wk. Allergic to penicillin: metronidazole + omeprazole, clarithromycin and S. boulardii (dosages not reported).
	Group B - Only triple therapy: Amoxicillin, omeprazole, clarithromycin. Allergic to penicillin: metronidazole + omeprazole, clarithromycin (dosages not reported).
Kasiri et al[29]	Group A - Amoxicillin-based triple therapy: Omeprazole 1–2 mg/kg b.i.d. for 1 mo. Amoxicillin 50 mg/kg and clarithromycin 15 mg/kg b.i.d. for 2 wk.
	Group B - Metronidazole-based triple therapy: Omeprazole 1 mg/kg b.i.d. divided into two doses for 1 mo. Metronidazole 15 mg/kg and clarithromycin 15 mg/kg b.i.d. for 2 wk.
Iwańczak et al[30]	Group I - Amoxicillin-based triple therapy: Omeprazole, amoxicillin and clarithromycin for 7 d (dosages not reported).
	Group II - Metronidazole-based triple therapy: Omeprazole, amoxicillin and metronidazole for 7 d (dosages not reported).
	Group III - Sequential therapy: omeprazole 1 mg/kg of body weight/d, max 20 mg b.i.d. and amoxicillin 50 mg/kg of body weight/d, max 1000 mg/24 h for 5 d, b.i.d. followed by 5 d treatment with omeprazole 1 mg/kg of body weight/d, max 20 mg/24 h twice daily, clarithromycin 15 mg/kg of body weight/d, max 500 mg/24 h twice daily and metronidazole 20 mg/kg of body weight/d, max 500 mg/24 h twice daily.
Tümgör et al[31]	Group A - Clarithromycin-based triple therapy: Lansoprazole 1 mg/kg/d, amoxicillin 50 mg/kg/d, and clarithromycin 14 mg/kg/d, all medications b.i.d. for 14 d.
	Group B - Clarithromycin-based triple therapy + vitamin E: Lansoprazole 1 mg/kg/d b.i.d., amoxicillin 50 mg/kg/d b.i.d., and clarithromycin 14 mg/kg/d b.i.d., vitamin E 200 IU/d for 14 d.
Ali Habib et al[32]	Group A - Standard therapy: Rabeprazole 20 mg, clarithromycin 250 mg, and amoxicillin 500 mg each administered orally twice daily for 10 d.
	Group B - Sequential therapy: Rabeprazole 20 mg and amoxicillin 500 mg for 5 d, followed by rabeprazole 20 mg clarithromycin 250 mg and tinidazole 500 mg for another 5 d, twice daily.
Ustundag et al[33]	Group A - Standard triple therapy: Amoxicillin 50 mg/kg/d, clarithromycin 15 mg/kg/d twice daily for 14 d and omeprazole 1 mg/kg/d once daily for 1 mo.
	Group B - Standard triple therapy + symbiotic: Amoxicillin 50 mg/kg/d and clarithromycin 15 mg/kg/d twice daily for 14 d. Omeprazole 1 mg/kg/d once daily for 1 mo and Maflor® a single dose for 14 d concurrently.
Huang et al[34]	Group A – 1 d sequential therapy: Omeprazole 0.8–1.0 mg/kg/d, amoxicillin 30 mg/kg/d for the first 5 d, followed by omeprazole 0.8–1.0 mg/kg/d, clarithromycin 20 mg/kg/d, and metronidazole 20 mg/kg/d for the remaining 5 d.
	Group B – 7 d triple standard therapy: Omeprazole 0.8–1.0 mg/kg/d, amoxicillin 30 mg/kg/d, and clarithromycin 20 mg/kg/d.
	Group C – 10 d triple standard therapy: Omeprazole 0.8–1.0 mg/kg/d, amoxicillin 30 mg/kg/d, and clarithromycin 20 mg/kg/d.
N Şirvan et al[35]	Group 1 - Standard triple therapy + symbiotic: Amoxicillin 50 mg/kg/d b.i.d. for 7 d, clarithromycin 15 mg/kg/d b.i.d. for 14 d, and lansoprazole 1 mg/kg/d - single dose, in the morning for 14 d. Maflor® sachet - single dose for 14 d.
	Group 2 - Standard triple therapy: Amoxicillin 50 mg/kg/d b.i.d. for 14 d, clarithromycin 15 mg/kg/d b.i.d. for 14 d, and lansoprazole 1 mg/kg/d - single dose, in the morning for 14 d.
Baysoy et al[36]	Group A - Standard triple therapy: Amoxicillin 50 mg/kg/d, clarithromycin 15 mg/kg/d, and lansoprazole 1 mg/kg/d for 14 d.
	Group B - Sequential therapy group: Amoxicillin 50 mg/kg/d and lansoprazole 1 mg/kg/d for the first 5 d and clarithromycin 15 mg/kg/d, ornidazole 30 mg/kg/d and lansoprazole 1 mg/kg/d for another 5 d.
Esmaeili-Dooki et al[37]	Group 1 - Clarithromycin-based triple therapy: Clarithromycin 7.5 mg/kg/d b.i.d. and amoxicillin 50 mg/kg/d every b.i.d. for 10 d, and omeprazole 1 mg/kg/d b.i.d. for 2 wk.
	Group 2 - Amoxicillin-based triple therapy: Azithromycin 10 mg/kg/d once a day, before meal, for 6 d along with amoxicillin and omeprazole.
Laving et al[38]	Conventional therapy group: Omeprazole plus 1 mg/kg/d, amoxicillin plus 50 mg/kg/d and clarithromycin 15 mg/kg/d for 10 d.
	10 d sequential therapy group: Omeprazole plus 1 mg/kg/d, amoxicillin plus 50 mg/kg/d for 5 d followed by omeprazole plus 1 mg/kg/d, clarithromycin 15 mg/kg/d, and tinidazole 20 mg/kg/d for the next 5 d.
Prieto-Jimenez et al[39]	Group I - Quadruple sequential eradication and placebo: Lansoprazole, once per day before breakfast, plus an oral solution containing amoxicillin 50 mg/kg/d for 5 d followed by lansoprazole, once per day, plus an oral solution containing clarithromycin 15 mg/kg/d and an oral solution containing tinidazole 20 mg/kg/d for another 5 d. 6 wk of a placebo matched to iron supplementation.
	Group II - Quadruple sequential eradication and iron: Lansoprazole, once per day before breakfast, plus an oral solution containing amoxicillin 50 mg/kg/d for 5 d followed by lansoprazole, once per day, plus an oral solution containing clarithromycin 15 mg/kg/d and an oral solution containing tinidazole 20 mg/kg/d for another 5 d. 6 wk of iron supplementation.
	Group III: Iron and placebo: A 10 d course of a placebo matched to H pylori sequential eradication therapy plus 6 wk of iron supplementation.
	Group IV: Placebo alone: A 10 d course of placebo matched to H. pylori sequential eradication therapy plus 6 wk of a placebo matched to iron supplementation.
Nguyen et al[40]	Group A: Lansoprazole, amoxicillin and clarithromycin: (1) Children weighing 13–22 kg: lansoprazole 15 mg once daily, amoxicillin 500 mg twice daily and clarithromycin 250 mg once daily; and (2) Children weighing 23–45 kg: lansoprazole 15 mg, amoxicillin 750 mg and clarithromycin 250 mg, all given twice daily.
	Group B: Lansoprazole, amoxicillin and metronidazole: (1) Children weighing 13-22 kg: lansoprazole 15 mg once daily, amoxicillin 500 mg and metronidazole 250 mg twice daily; and (2) Children weighing 23–45 kg: Lansoprazole 15 mg, amoxicillin 750 mg and metronidazole 500 mg, all given twice daily.
Bontems et al[41]	Group A: 10 d sequential treatment: 5 d therapy with a combination of omeprazole (10 mg b.i.d. below 30 kg body weight or 20 mg b.i.d. above 30 kg) and amoxicillin 25 mg/kg b.i.d.—maximum 2 g/d), followed by 5 d of omeprazole, clarithromycin (7.5 mg/kg b.i.d.—maximum 1 g/d), and metronidazole (10 mg/kg b.i.d.—maximum 1.5 g/d).
	Group B: 7 d triple therapy: 7 d treatment tailored comprising omeprazole and amoxicillin with clarithromycin in cases of H. pylori strains susceptible to clarithromycin or with clarithromycin in cases of H. pylori strains susceptible to metronidazole and resistant to clarithromycin.

H. pylori: Helicobacter pylori.