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

The tolerability of Helicobacter pylori ( H. pylori )eradication regimens in children remains a clinical concern, particularly regarding gastrointestinal adverse effects and treatment discontinuation. The aim of this study was to compare the tolerability of different H. pylori eradication regimens in children by evaluating treatment-related symptoms, symptom worsening during therapy, and treatment completion rates. Pediatric patients with endoscopically confirmed H. pylori infection were treated with clarithromycin-based, metronidazole-based, or bismuth-containing regimens. All eradication regimens were administered for 14 days. Symptom severity was graded using a standardized scoring system, and stool pattern was assessed using the Bristol Stool Scale. Symptom worsening was defined as an increase compared with baseline. Within-group comparisons were performed using the Wilcoxon signed-rank test, and between-group differences were analyzed using chi-square or Fisher’s exact test. A p value < 0.05 was considered statistically significant. In the overall study population, nausea, vomiting, metalic taste and anorexia scores increased significantly during treatment compared with baseline (Wilcoxon signed-rank test, p < 0.05). However, symptom worsening rates and stool pattern changes did not differ significantly among treatment groups (all p > 0.05). A total of 16 patients discontinued therapy. Discontinuation rates were 9.1% in the clarithromycin-based group, 2.4% in the metronidazole-based group, and 12.0% in the bismuth-containing group, with no statistically significant difference between groups ( p = 0.204). Vomiting was the most common reason for treatment interruption, followed by diarrhea. The evaluated H. pylori eradication regimens showed comparable tolerability and treatment completion rates in children. Treatment selection may therefore be guided primarily by eradication efficacy and antimicrobial resistance patterns rather than concerns regarding adverse effects alone.