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Antimicrobial treatment was well accepted with total compliance; side effects (metallic and bitter taste) were reported in two patients (8%).

Overall eradication rate was 64% (IC (95%) = 45-83%). Fifteen patients used 10 days antimicrobial treatment regimen and Hp infection was eradicated in 11 patients (73% - IC (95%) = 51-95%).

Endoscopic diagnosis was nodular gastritis in four, erosive duodenitis in three, normal in three, and duodenal ulcer in one; 7/11 (64%) presented total remission of symptoms, but symptoms persisted in four (36%), 2/4 with erosive duodenitis, one with gastritis and one with normal exam; 2/4 who remained infected became asymptomatic, both with normal endoscopy.

Ten patients used 7 days antimicrobial treatment regimen and Hp was eradicated in five (50% - IC (95%) = 19-81%). Endoscopic diagnosis was nodular gastritis in

three

This therapy with CAO eradicated Hp from the gastric mucosa with an overall eradication rate of 64%.

Ten days course of antimicrobial treatment achieves 73% eradication rate and 7 days course achieves 50%. Our small sample could be a big one due to higher prevalence of Hp infection in our dyspeptic children.

We really selected only children who routinely have Hp treatment indicated in our institution. All of them present severe epigastric symptoms or peptic disease in their relatives. This eradication rate was higher than previous triple therapy used in our institution: colloidal bismuth subcitrate, amoxicillin and nitroimidazole compounds (metronidazole or tinidazole) during 1 week (35%) and during 2 weeks (40%) (13) and triple therapy with omeprazole, clarithromycin and nitroimidazole (metronidazole or tinidazole) during 2 weeks (25%) (21) . Thus, the non-inclusion of nitroimidazole seems very important on account of prior low rates of Hp eradication in children of our country. Clarithromycin resistance ranges from 5% to 15%, in European studies (23, 30) and is increasing in children because of the widespread use in pediatric practice, mainly in developed countries. The poor compliance could be another important reason for this low rate of eradication.

The problems associated with poor compliance, such as treatment failure, development of drug resistance and the expenses and inconvenience of further investigation and therapy, make it imperative to find a short course, highly effective and well tolerated regimen. Side effects, a factor contributing to non-compliance, occurred in only two patients (8%), less than that reported by KATO et al.

Clarithromycin can cause metallic taste, nausea, vomiting or diarrhea. The patients must be advised to continue the treatment even if these symptoms occur.

(12) noted a high eradication rate (92%) using CAO therapy for Hp ulcer disease and nodular gastritis in a smaller sample (12 children), but our result was similar to other two studies using CAO therapy: in 32 Swedish children for 2 weeks (75%) (29) and in 45 Italian children (78%) (20) . A long-term study is important to determine the effect of Hp eradication on remission or recurrence of symptoms in children with Hp positive gastritis without peptic ulcer.

Similar studies have shown resolution of symptoms in non-eradicated infection like we observed in this study (5, 9, 12) . 13 C urea breath test is considered the best test to assess Hp eradication in children and adults, but in developing countries, endoscopy is more accessible than this high-cost non-invasive method. In this study we used this test only in selected children because 13 C urea breath test is not routinely available in our institution. The long-term eradication in children of low socioeconomic level in developing countries has to be determined.

There are no studies evaluating the reinfection rate.

In developed countries, although rare, reinfection is most common in children younger than 5 years old (27) Hp infection is common among relatives (19) . Treatment of relatives of Hp infected children promoted good compliance to antimicrobial treatment (11, 19) and could act by lowering the reinfection. In our institution, we always submitted the relatives to Hp treatment if they presented peptic ulcer. We approach the symptomatic relatives of duodenal ulcer children regarding Hp investigation, although different strains can be identified in the same family and more than one strain can be present in the same individual (1) . In summary, a 10-day course of CAO resulted in 73% eradication of Hp infection and 7-days course resulted in 50%. Further studies with a bigger sample and search

for

Terapia triplice com claritromicina, amoxicilina e omeprazol para erradicacao do Helicobacter pylori em criancas e adolescentes.

RESUMO ? Racional ? Apesar da alta prevalencia da infeccao por Helicobacter pylori em paises em desenvolvimento, existem poucos ensaios pediatricos avaliando o tratamento antimicrobiano para erradicacao.

Objetivo - Avaliar a eficacia de esquema triplice contendo claritromicina, amoxicilina e omeprazol para erradicacao da infeccao por Helicobacter pylori durante 7 e 10 dias. Pacientes e Metodos - Vinte e cinco criancas e adolescentes Helicobacter pylori positivo com queixas dispepticas de forte intensidade foram submetidas a tratamento com amoxicilina (50 mg/kg/dia - dose maxima 1 g bid), claritromicina (30 mg/kg/dia - dose maxima 500 mg bid) e omeprazol (0,6 mg/kg/dia - dose maxima 20 mg bid), durante 7 e 10 dias.

Apos 2 meses, realizou-se controle clinico e biopsia gastrica para avaliar erradicacao do Helicobacter pylori.

Resultados - Helicobacter pylori foi erradicado em 16/25 pacientes (64% - IC(95%) = 45-83%), em 11/15 (73% - IC(95%) - 51-95%) que utilizaram esquema antimicrobiano por 10 dias e em 5/10 (50% - IC(95%) = 19-81%) que utilizaram o esquema por 7 dias.

Houve boa aceitacao do tratamento antimicrobiano e efeitos colaterais ocorreram em dois pacientes (8%).

Conclusoes - O indice de erradicacao obtido (64%) foi de eficacia moderada. Os dados da presente serie sugerem que o esquema antimicrobiano por 10 dias (73%) seja mais eficaz que o esquema por 7 dias (50%) para tratamento da infeccao por Helicobacter pylori em nossa populacao, embora seja necessaria amostragem maior. Bamford KB, Bickley J, Collins JS, Johnston BJ, Pott S, Boston V, Owen RJ, Sloan JM. Helicobacter pylori comparison of DNA fingerprints provides evidence for intrafamilial infection. Banatvala N, Davies GR, Abdi Y, Clements L, Rampton DS, Hardie JM, Feldman RA.

High prevalence of Helicobacter pylori metronidazole resistance in migrants to east London: relation with previous nitromidazole exposure and gastroduodenal disease.

Barabino A, Dufour C, Marino CE, Claudiani F, Alessandri AD.

Unexplained refractory iron deficiency anemia associated with Helicobacter pylori gastric infection in children: further clinical evidence.

Helicobacter pylori and peptic disease in pediatric patient. Effective 2-wk therapy for Helicobacter pylori disease in children. Helicobacter pylori infection in children: a consensus statement. Current European concepts in the management of Helicobacter pylori .

Fiedoreck SC, Casteel HB, Pumphrey CL, Evans DJ Jr, Evans DG, Klein PD, Graham DY. The role of Helicobacter pylori in recurrent, functional abdominal pain in children.

Treatment and long-term follow-up of Helicobacter pylori associated duodenal ulcer disease in children. Is Helicobacter pylori associated with non-ulcer dyspepsia and will eradication improve symptoms? Managing intrafamilial dissemination of Helicobacter pylori gastric infection improves eradication rates in children [letter].

Omeprazole-based dual and triple regimens for Helicobacter pylori eradication in children. In: Farhat CK, Carvalho ES, Carvalho LHFR, Succi RCM, editores. Gastrite primaria associada ao Helicobacter pylori em criancas.

Kiyota K, Habu Y, Sugano Y, Inokuchi H, Mizuno S, Kimoto K, Kawai K. Comparison of amoxicillin 1000 mg uses 1-week and 2-week triple therapy with omeprazole, amoxycillin, and clarithromycin in peptic ulcer patients with Helicobacter pylori infection: results of a randomized controlled trial. Iron-deficiency anemia associated with Helicobacter pylori gastritis. Helicobacter pylori infection and childhood recurrent abdominal pain: lack of evidence for a cause and effect relationship.

Miyaji H, Azuma T, Ito S, Suto H, Ito Y, Yamazaki Y, Sato F, Hirai M, Kuriyama M, Kato T, Kohli Y.

Susceptibility of Helicobacter pylori isolates to metronidazole, clarithromycin and amoxycillin in vitro and in clinical treatment in Japan. Oderda G, Ponzetto A, Boero M, Bellis D, Forni M, Vaira D, Ansaldi N. Family treatment of symptomatic children with Helicobacter pylori infection.

Management of Helicobacter pylori infection in children. Avaliacao de esquema triplice contendo claritromicina, citrato de bismuto coloidal e derivados nitroimidazolicos no tratamento de erradicacao do Helicobacter pylori .

In: IX Congresso Brasileiro de Gastroenterologia Pediatrica, Natal, 1998. Patchett S, Beattie S, Leen E, Keane C, O'Morain C. Eradicating Helicobacter pylori and symptoms of non-ulcer dyspepsia. Pilotto A, Leandro G, Franceschi M, Rassu M, Bozzola L, Furlan F, Di Mario F, Valerio G.

The effect of antibiotic resistance on the outcome of three 1-week triple therapies against Helicobacter pylori .

Queiroz DMM, Coimbra RS, Mendes EN, Rocha GA, Alves VML, Oliveira CA, Lima Jr GF. Metronidazole-resistant Helicobacter pylori in a developing country.

Cure of duodenal ulcer associated with eradication of Helicobacter pylori . How should Helicobacter pylori infected children be managed?

Rowland M, Kumar D, Daly L, O'Connor P, Vaughan D, Drumm B.

Low rates of Helicobacter pylori reinfection in children.

Sherman P, Hassai E, Hunt RH, Fallone CA, Veldhuyzen van Zanten, Thomson ABR.

Canadian Helicobacter Study Group Consensus Conference on the approach to Helicobacter pylori infection in children and adolescents. Helicobacter pylori gastritis in children: efficacy of 2 weeks of treatment with clarithromycin, amoxicillin and omeprazole. Clarithromycin resistance in Helicobacter pylori : prevalence in untreated dyspeptic patients and stability in vitro.

Division of Pediatric Gastroenterology, Federal University of Sao Paulo - "Escola Paulista de Medicina" - UNIFESP-EPM, Sao Paulo, SP, Brazil.

* Assistant Professor, Division of Pediatric Gastroenterology, UNIFESP-EPM.

** Postgraduate student, Division of Pediatric Gastroenterology, UNIFESP-EPM.

*** Assistant Professor, Division of Pediatric Gastroenterology - Faculdade de Medicina da Santa Casa de Sao Paulo. **** Assistant Professor, Department of Medical Pathology, UNIFESP-EPM.

Elisabete Kawakami - Rua Pedro de Toledo, 441 - Vila Clementino - 04039-031 - Sao Paulo - SP - Brazil. All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License. Seng, 320 01331-020 Sao Paulo - SP Brasil Tel./Fax: +55 11 3147-6227. Viagra is well-known medicine for erectile dysfunction (impotence) treatment. Cialis will help you to improve your erection during sexual intercourse.

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International license number 10611211 issued 17 aug 2016.

As doctors, we tend to settle into habitual prescribing patterns—but, we must make sure that we always fully consider the patient’s needs. As a pharmacist practicing in a hospital setting, I could tell you the physician’s name based solely on his or her admitting medication orders.

Most doctors become comfortable using certain medications and dosing regimens, and we all have a preferred drug of choice for most conditions. We become well educated in the proper use, contraindications and side effects of our chosen agent, and we usually have a standard second choice when confronted with an allergic history or other patient-specific concern.

As an optometrist and pharmacist, I am fortunate to have a view from both sides of the counter.

Oral Antibiotics Optometrists’ most commonly used oral medications are antibiotics.

We treat skin and soft tissue infections, such as preseptal cellulitis, dacryocystitis and dacryoadenitis. Most of these infections are caused by gram-positive organisms—namely, strains of Staphylococcus or Streptococcus —and my drug of choice is amoxicillin.

This aminopenicillin has extended coverage for gram-positive and some gram-negative organisms and demonstrates increased resistance to beta-lactamases when compared to standard penicillin. In the past, Augmentin (amoxicillin/clavulanic acid, GlaxoSmithKline) was my drug of choice due to concerns about periorbital infections and the gram-negative organism Haemophilus influenzae, especially in young children.

With the advent of the Haemophilus influenzae B (Hib) vaccine, which has been given routinely to all children in the U.S. 1 Augmentin, however, remains an excellent choice and is preferred by some clinicians.

Keep in mind that the generic formulation is still somewhat costly, and that more gastrointestinal side effects are likely than with standard amoxicillin.

2 The adult dose for both amoxicillin and amoxicillin/clavulanic acid is 875mg b.i.d. The pediatric dose is 20 mg/kg/day to 40mg/kg/day, divided q8h.

A Case Study in Pediatric Dosage Adjustment 13 A 6-year-old Hispanic female presents with preseptal cellulitis.

She is not allergic to any medications, she has no other pertinent systemic health conditions, and her mother tells us she weighed 49 lbs.