Does H. pylori therapy augments the effect of iron therapy among children with iron deficiency anemia?

Background: To assess beneficial effects of H. pylori therapy on children with pre-existing Iron Deficiency Anemia (IDA).Methods: A total of 218 consecutive patients with iron deficiency anemia (Hb 6-11 gm/dl) were invited to participate in the study. Patients underwent endoscopic biopsy and rapid urease test for H. pylori detection. A total of three groups were formed- Group I (n=13) - positive for H. pylori, underwent treatment for H. pylori therapy and IDA, Group II (n=16) - positive for H. pylori, underwent treatment for IDA only, Group III (n=101) - negative for H. pylori, underwent treatment for IDA only. All the patients were followed up after every 4 weeks till week 12. Change in haematological parameters and anaemic and iron status was assessed. Chi-square paired 't'-test and ANOVA were used using SPSS 21.0.Results: All the 3 groups showed a significant increase in S. Hb, Ferritin and iron levels and a decrease in S. TIBC levels. At 12 weeks, mean S. ferritin and S. iron levels were significantly higher in Groups I and III as compared to Group II while Mean S. TIBC levels were significantly higher in Group II as compared to that in Groups I and II. A total of 73.3% of Group III, 53.8% of Group I and 56.3% of Group II patients had hemoglobin levels >11 g/dl, but difference was not significant (p=0.175).Conclusions: The findings of study showed that H. pylori therapy augments the effect of iron therapy among H. pylori positive children with iron deficiency anemia.

Current status of anti-diarrheal and anti-secretory drugs in the management of acute childhood diarrhea.

Each year 1.8 million children die due to diarrheal diseases. Indiscriminate use of antibiotics has resulted in increasing resistance to commonly used antibiotics. Moreover the recent outbreaks of shigella and cholera have revealed multi-drug resistance strains. There is a need for review of recommended antibiotics for shigellosis. From recent data it emerges that fluoroquinolones should be the first line of therapy and cephalosporins to be used as the second line. Among the anti-cholera antibiotics, tetracyclines which were the drug of choice for adults, has the advantage of high sensitivity and low cost. Single dose doxycycline would have minimal side effects, hence can be the drug of choice even in children. We should not allow the business pressures to force usage of probiotics and racecadotril as their role in the management of acute diarrhea is yet to be established. Nitazoxanide has high efficacy against Cryptosporodial diarrhea only. Strict adherence to the recommendations for the management of acute childhood diarrhea is needed or else we dilute the effect of standard management.