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TRATAMENTO DA INFECÇAO POR HELICOBACTER PYLORI EM CRIANÇAS E ADOLESCENTES

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kawakami.jpg Autor:
Elisabete Kawakami
Columnista Experto de SIIC
Artículos publicados por Elisabete Kawakami
Coautor
Silvio Kazuo Ogata -* 
Mestre e Pós-graduando da Disciplina de Gastroenterologia Pediátrica da Universidade Federal de São Paulo - Escola Paulista de Medicina.*
Recepción del artículo
21 de Abril, 2003 		Primera edición
23 de Julio, 2003 		Segunda edición, ampliada y corregida
7 de Junio, 2021

TRATAMENTO DA INFECÇAO POR HELICOBACTER PYLORI EM CRIANÇAS E ADOLESCENTES

Resumen
Existem poucos ensaios terapêuticos para avaliação da eficácia do tratamento de erradicação do H.pylori em crianças, ao contrário do relatado na literatura médica em pacientes adultos. A grande maioria é de estudos abertos, não randomizados, não havendo nenhum placebo controlado. Além disto, não há critérios mínimos para determinar a eficácia, assim como critérios homogêneos na seleção de pacientes. O tratamento medicamentoso deve ser sempre testado em cada região, dado a diversidade na aderência, cepas diferentes e resposta do hospedeiro. Em criança, geralmente o esquema terapêutico a ser testado baseia-se em tratamentos já testados em pacientes adultos, dada a menor indicação de tratamento, devido á baixa prevalência de úlcera péptica, que constitui a principal indicação de tratamento em pacientes adultos. O tratamento inicial mais recomendado consiste de esquema tríplice com inibidor da bomba de prótons associado a dois antimicrobianos: claritromicina, amoxicilina ou metronidazol em duas tomadas diárias por 1 ou 2 semanas. Estudo duplo-cego com terapia tríplice contendo amoxicilina, claritromicina e omeprazol por uma semana, comparado com terapia dupla com claritromicina e amoxicilina apresentou erradicação em 75% e 9,4% respectivamente. Estudo aberto em nosso serviço com o mesmo esquema tríplice, apresentou eficácia menor (50% e 73%) utilizando o mesmo esquema durante 7 e 10 dias. Avaliação de novo esquema tríplice (claritromicina, furazolidona e inibidor da bomba de prótons - 7 dias) tem mostrado melhor índice de erradicação, dado já comprovado em pacientes adultos de nosso país. A falha no tratamento tem sido associado a fatores como aderência ao tratamento ou as características próprias do H.pylori como resistência bacteriana aos antimicrobianos e a capacidade do H.pylori em se aderir ao epitélio gástrico, abaixo da camada de muco, dificultando o acesso das drogas antimicrobianas. Acredita-se que os marcadores de virulência também influenciem na eficácia da erradicação. Quando não há resposta ao tratamento inicial, recomenda-se o esquema quádruplo baseado em drogas não prescritas anteriormente, devido á resistência antimicrobiana secundária; mas o ideal seria um esquema antimicrobiano baseado no estudo de resistência bacteriana através de cultura da bactéria e antibiograma.

Palabras clave
Helicobacter pylori, crianças, adolescentes, erradicação


Artículo completo
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Abstract
There are few available data about evaluation of eradication treatment efficacy in children, frequently with open, no randomized and no controlled studies. There are no minimum criteria to determine efficacy or selection of patients for the studies. The recommended first line treatment consists of proton pump inhibitor plus two antibiotics clarithromycin, amoxicillin, or metronidazole, twice a day, during 1 or 2 weeks. Double blind assay using triple therapy - clarithromycin, amoxicillin and omeprazole during 1 week, compared with double therapy using clarithromycin and amoxicillin presents eradication rate in 75% and 9,4% respectively. In our country, open assay using the same schedule presents lower efficacy (50% and 73%) during 7 and 10 days. A new triple therapy for H.pylori eradication has been evaluated (clarithromycin, furazolidone and proton pump inhibitor - 7 days) showing better eradication rate, that was demonstrated by adult assay in our country. Treatment failure has been associated with no compliance to treatment or due to H. pylori characteristics, like antimicrobials resistance and H.pylori capacity to adhere to gastric epithelium above mucus, decreasing antimicrobials drugs access. Maybe virulence markers also influence eradication efficacy. When first line treatment fails, quadruple regimen is recommended, based on previous not used drugs, but because secondary antimicrobial resistance, the best way would be an antimicrobial schedule based on culture and antibiogram.

Key words
Helicobacter pylori, crianças, adolescentes, erradicação

Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Pediatría
Relacionadas: Epidemiología, Gastroenterología, Infectología, Medicina Familiar, Medicina Interna



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