Influence of parental compliance on the effectiveness of treatment of chronic gastroduodenal pathology in children

Аннотация

Introduction: The article focuses on the studies which point to particular difficulties in achieving compliance in pediatrics. A dangerous trend to escalate the number and doses of antibiotics in anti- Helicobacter pylori (HP) schemes, the dosage frequency and course duration of eradication therapy considerably complicates a patient’s compliance to the treatment and contributes to a further growth of HP antibiotic resistance. In the treatment of children, the control of the outpatient therapy largely depends on the patient’s parents.

Materials and methods: At the first stage of the study, 103 children with chronic gastroduodenal pathology associated with HP were examined. Diagnosis of the disease was based on the study of complaints, the anamnesis data, and the results of the endoscopic examination. All the patients underwent a course of anti-HP therapy in the outpatient setting. A degree of parental compliance to their child’s therapy was determined in by a questionnaire, which had been developed by us, the families of the children suffering from chronic gastroduodenal pathology. At the second stage, 80 children suffering from peptic ulcer associated with HP were examined. HP was eradicated in the outpatients of both groups, using an anti-HP regimen: omeprazole, clarithromycin, and amoxicillin administered for 14 days. The influence of the measures to improve parental compliance carried out in tandem “doctor – pharmacist” in the families with children suffering from chronic gastroduodenal pathology was studied.

Results and discussion: A decrease in parental compliance was observed in more than 2/3 of the families with children suffering from chronic gastroduodenal pathology, associated with HP infection. A higher level of parental compliance was established in the families of children after the ”compliance training”. In the patients of this group, eradication of HP was achieved in 87.5% cases by using a traditional scheme: omeprazole, clarithromycin, and amoxicillin administered for 14 days.

Conclusion: It can be concluded that the level of parental compliance to an anti-HP therapy for their children is insufficient. In turn, conducting a “compliance training” in the tandem of ”doctor – pharmacist” before starting the therapy is an important factor in increasing the level of parental compliance, which is reflected in increasing the effectiveness of the treatment. Strict adherence to the regimen and duration of administration of the prescribed drugs in children with ulcer allows achieving a high level of HP eradication – 95.2 %, even when using the traditional anti-HP regimen.

The eradication was achieved in 56.5 % of the children with partial parental compliance, and only in 6.7 % of the children with non-compliant parents