Pediatric H. pylori regimen comparison finds similar observed tolerability

Three 14-day Helicobacter pylori eradication regimens produced broadly similar observed tolerability in children with endoscopically confirmed infection, according to a comparative study published in BMC Infectious Diseases. Across the cohort, nausea, vomiting, metallic taste and anorexia increased significantly during treatment relative to baseline, but symptom-worsening rates, stool-pattern changes and treatment discontinuation did not differ significantly among the clarithromycin-based, metronidazole-based and bismuth-containing groups.

The clinical comparison included pediatric patients whose H. pylori infection had been confirmed by endoscopy. Children received one of the three eradication regimens, each administered for 14 days. Researchers recorded treatment-related symptoms with a standardized severity-scoring system and assessed stool pattern with the Bristol Stool Scale. Symptom worsening was defined as an increase in severity compared with the baseline measurement, enabling investigators to assess not only whether a child finished therapy but also whether specific adverse effects became more prominent during it.

For comparisons within a treatment group, investigators used the Wilcoxon signed-rank test; chi-square or Fisher’s exact tests were used to assess differences between groups. A p value below 0.05 was considered statistically significant. The analysis identified significant increases in the recorded scores for nausea, vomiting, metallic taste and anorexia when the overall population during treatment was compared with baseline. However, the proportion of patients experiencing symptom worsening did not differ significantly among the three regimens. Stool-pattern changes also showed no statistically significant differences between groups. These results indicate similar observed tolerability patterns, rather than proving that the regimens were strictly equivalent.

Treatment completion followed the same broad pattern. Sixteen patients discontinued therapy, corresponding to rates of 9.1% in the clarithromycin-based group, 2.4% in the metronidazole-based group and 12.0% in the bismuth-containing group. The difference was not statistically significant (p = 0.204). Although the bismuth-containing group had the highest observed discontinuation rate and the metronidazole-based group the lowest, the comparison did not establish a reliable difference among the regimens. Vomiting was the most common reason for interrupting treatment, followed by diarrhea.

The findings do not, by themselves, establish the eradication efficacy of any regimen or describe antimicrobial-resistance patterns. Nor do they demonstrate that one treatment is preferable for an individual child. The study instead suggests that the three approaches had comparable recorded adverse-effect and completion profiles in this pediatric cohort, while also showing that several symptoms became more severe during the 14-day treatment period. The reported tolerability results may therefore be considered alongside eradication performance and resistance patterns, as proposed by the authors, without treating the absence of significant differences as proof of equivalence. The article was shared in an early-access version on 4 September 2026 and was described as citable but subject to further editorial revision before the final version of record.

Subject of Research: Comparative tolerability of three 14-day H. pylori eradication regimens in children

Article Title: Comparable tolerability, symptom worsening, and treatment completion rates among different Helicobacter pylori eradication regimens in children

Article References: Gürcan Kaya, N., & Selbuz, S. (2026). Comparable tolerability, symptom worsening, and treatment completion rates among different Helicobacter pylori eradication regimens in children. BMC Infectious Diseases, 26(1), Article 1680. https://doi.org/10.1186/s12879-026-14033-8

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14033-8

Keywords: Helicobacter pylori, pediatrics, eradication therapy, treatment tolerability, adverse effects, symptom severity, treatment completion, Bristol Stool Scale, bismuth, clarithromycin, metronidazole, Comparable