How to diagnose Helicobacter pylori (H. pylori) infection in a 2-year-old child and what is the appropriate treatment if positive?

From the Guidelines

To check for H. pylori in a 2-year-old child, the most appropriate tests are the stool antigen test or the urea breath test, as they are non-invasive and well-tolerated by young children 1. The stool antigen test is often preferred for toddlers since it doesn't require cooperation for breath collection. Some key points to consider when checking for H. pylori in a 2-year-old child include:

• Blood antibody tests are less reliable in children this young 1
• The presence of H. pylori infection can be confirmed by a urea breath test (UBT), stool antigen test, or endoscopy depending on the presentation 1
• Noninvasive tests for active infection include the UBT and the stool antigen test, which are susceptible to any action that decreases the bacterial load in the stomach, such as use of antibiotics, bismuth, or proton pump inhibitors (PPIs) 1 If H. pylori is confirmed positive, treatment typically involves triple therapy for 7-14 days consisting of two antibiotics plus a proton pump inhibitor (PPI), with a common regimen being amoxicillin, clarithromycin, and a PPI such as omeprazole 1. A common regimen would be:
• Amoxicillin (50 mg/kg/day divided twice daily, maximum 1g twice daily)
• Clarithromycin (15 mg/kg/day divided twice daily, maximum 500mg twice daily)
• A PPI such as omeprazole (1 mg/kg/day divided twice daily) Alternative regimens may be used if there are concerns about antibiotic resistance. It's essential to:
• Complete the full course of treatment even if symptoms improve
• Perform a follow-up stool antigen test at least 4 weeks after completing therapy to confirm eradication Treatment in young children should be supervised by a pediatric gastroenterologist as H. pylori infection is less common in this age group, and symptoms may be due to other causes. Some potential side effects of treatment to monitor closely include:
• Diarrhea
• Nausea
• Taste disturbances

From the FDA Drug Label

Based on the results of these studies, the safety and efficacy of 2 different eradication regimens were established: Triple therapy:Amoxicillin 1 gram twice daily/clarithromycin 500 mg twice daily/lansoprazole 30 mg twice daily Dual therapy:Amoxicillin 1 gram three times daily/lansoprazole 30 mg three times daily H pylorieradication was defined as 2 negative tests (culture and histology) at 4 to 6 weeks following the end of treatment.

To check for H. pylori in a 2-year-old, the following methods can be considered:

• Culture: a test to check for the presence of H. pylori bacteria in the stomach
• Histology: a test to check for the presence of H. pylori bacteria in the stomach tissue
• CLOtest: a test to check for the presence of H. pylori bacteria in the stomach

If the test is positive, the treatment options are:

• Triple therapy: Amoxicillin 1 gram twice daily, clarithromycin 500 mg twice daily, and lansoprazole 30 mg twice daily for 14 days
• Dual therapy: Amoxicillin 1 gram three times daily and lansoprazole 30 mg three times daily for 14 days

However, the provided label does not specify the dosage for a 2-year-old child. Therefore, the treatment should be determined by a healthcare professional. 2

From the Research

Diagnosis of H. Pylori in a 2-Year-Old

• The diagnosis of H. pylori in children can be done using non-invasive methods such as the 13C-urea breath test 3, 4 or invasive methods like endoscopy with biopsy and histology 5, 6.
• The 13C-urea breath test is a commonly used method for diagnosing H. pylori infection in children, as it is non-invasive and relatively easy to perform 3, 4.
• Endoscopy with biopsy and histology can also be used to diagnose H. pylori infection in children, especially if the child is experiencing symptoms such as abdominal pain or vomiting 5, 6.

Treatment of H. Pylori in a 2-Year-Old

• The treatment of H. pylori infection in children typically involves a combination of antibiotics and a proton pump inhibitor (PPI) 3, 4, 5, 7, 6.
• A common treatment regimen for H. pylori infection in children is a triple therapy consisting of a PPI, amoxicillin, and clarithromycin 5, 6.
• Quadruple therapy regimens, which add a fourth medication such as metronidazole to the triple therapy regimen, have also been shown to be effective in eradicating H. pylori infection in children 3, 4.
• The duration of treatment for H. pylori infection in children is typically 7-14 days, depending on the specific treatment regimen and the child's response to treatment 3, 4, 5, 7, 6.