From the Guidelines
For pediatric H. pylori treatment, the recommended first-line therapy is triple therapy consisting of a proton pump inhibitor (PPI) plus two antibiotics for 14 days, with specific dosing including amoxicillin 50 mg/kg/day divided twice daily (maximum 1 g twice daily), clarithromycin 15 mg/kg/day divided twice daily (maximum 500 mg twice daily), and a PPI at a standard dose twice a day 1. The choice of treatment regimen should be based on the knowledge of the underlying prevalence of resistant strains in the community, as the response to eradication therapy is significantly related to the prevalence of primary resistance in the population 1. Some key points to consider when treating pediatric H. pylori infection include:
- The importance of confirming treatment success with a urea breath test, stool antigen test, or endoscopy with biopsy at least 4 weeks after completing therapy and at least 2 weeks after stopping PPI therapy 1.
- The need for H. pylori eradication in children with peptic ulcer disease, iron deficiency anemia, or family history of gastric cancer, as the bacterium damages the gastric mucosa through inflammation and can lead to complications if left untreated 1.
- Alternative first-line options, such as bismuth quadruple therapy, may be considered in certain cases, but the standard triple therapy regimen is generally recommended as the first-line treatment 1. In cases where the first-line therapy fails, a second-line therapy, such as a 10-day levofloxacin-amoxicillin triple therapy, may be considered, with dosing including levofloxacin 500 mg once a day or 250 twice a day, amoxicillin 1000 mg twice a day, and a PPI at a standard dose twice a day 1.
From the FDA Drug Label
In Pediatric Patients over 3 Months of Age, 20 to 45 mg/kg/day in divided doses every 8 to 12 hours. For pediatric H. pylori treatment dosing using amoxicillin, the dose is 20 to 45 mg/kg/day in divided doses every 8 to 12 hours for patients over 3 months of age 2.
- The dose for neonates and infants aged 3 months or younger is not directly applicable for H. pylori treatment as the label only provides general dosing information for this age group.
- For H. pylori infection treatment in pediatric patients, the label does not provide specific dosing regimens, only referring to adult dosing regimens.
From the Research
Pediatric H. pylori Treatment Dosing
There are no research papers to assist in answering this question as the provided studies do not specifically address pediatric H. pylori treatment dosing.
Available Information on H. pylori Treatment
- The provided studies discuss various treatment regimens for H. pylori eradication in adults, including triple and quadruple therapies with different combinations of antibiotics and proton pump inhibitors 3, 4, 5, 6, 7.
- These studies report varying eradication rates and tolerability profiles for the different treatment regimens, but do not provide information on pediatric dosing.
- The studies suggest that the choice of treatment regimen may depend on factors such as antibiotic resistance patterns, patient demographics, and CYP2C19 genotype 4, 6.
- However, without specific data on pediatric patients, it is not possible to determine the appropriate dosing for this population.
Key Findings from Available Studies
- A study published in 1999 found that a higher dose of clarithromycin (500 mg b.d.) was more effective than a lower dose (250 mg b.d.) in eradicating H. pylori in adults 4.
- A 2013 study reported that a 14-day regimen of high-dose proton pump inhibitor, amoxicillin, and long-acting clarithromycin achieved a 100% eradication rate in adults with H. pylori infection 6.
- Another study published in 2012 compared the efficacy and tolerability of two different triple therapy regimens for H. pylori eradication in adults and found that the regimen containing omeprazole, metronidazole, and amoxicillin was more effective than the regimen containing lansoprazole, clarithromycin, and amoxicillin 7.