What is the recommended Helicobacter pylori (H. pylori) treatment regimen in pediatric patients?

From the Guidelines

The recommended treatment regimen for Helicobacter pylori infection in pediatric patients typically consists of triple therapy for 14 days, including a proton pump inhibitor (PPI) and two antibiotics, with the specific regimen chosen based on local resistance patterns and patient factors. When choosing a treatment regimen, it is essential to consider the prevalence of antibiotic resistance in the local population, as this can significantly impact the effectiveness of the treatment 1. The most commonly recommended triple therapy regimens include:

• A PPI such as omeprazole or lansoprazole, combined with amoxicillin and clarithromycin
• A PPI, combined with amoxicillin and metronidazole
• A PPI, combined with clarithromycin and metronidazole In areas with high clarithromycin resistance, bismuth-based quadruple therapy may be used as an alternative 1. It is crucial to note that treatment adherence is vital for successful eradication, and parents should be educated about the importance of completing the full course of therapy despite potential side effects like diarrhea, nausea, or taste disturbances 1. The treatment regimen should be chosen based on the most recent and highest-quality evidence available, taking into account local resistance patterns and patient factors, to maximize the chances of successful eradication and minimize the risk of complications and antibiotic resistance 1. Key considerations in choosing a treatment regimen include:
• The prevalence of antibiotic resistance in the local population
• The patient's medical history and potential allergies or interactions
• The specific antibiotics and PPI used, as well as their dosages and durations
• The potential for side effects and the importance of treatment adherence.

From the Research

Recommended Treatment Regimens

The recommended Helicobacter pylori (H. pylori) treatment regimen in pediatric patients varies depending on several factors, including age, symptoms, and antibiotic susceptibility.

• Aminopenicillin/bismuth or aminopenicillin/tinidazole combinations appear to be effective in eradicating H. pylori in children 2.
• Amoxicillin 50 mg/kg/d plus bismuth subsalicylate can be used for 6 weeks 2.
• Tinidazole 20 mg/kg/d can be used with amoxicillin 50 mg/kg/d for 6 weeks to treat children infected with H. pylori 2.
• Proton pump inhibitor (PPI)-based triple therapies with clarithromycin and either amoxicillin or metronidazole are recommended as first-line treatments for children with H. pylori infection 3.
• A two-week therapy with a nitroimidazole and amoxicillin, or a two-week regimen of bismuth, amoxicillin, and metronidazole, may be effective in children 3.

Considerations for Treatment

When treating H. pylori infection in children, several factors should be considered, including:

• Antibiotic susceptibility testing to minimize unsuccessful treatment rates 4.
• The use of gastroscopy with antimicrobial susceptibility testing by culture on gastric biopsies to evaluate all possible causes of symptomatology and increase the eradication rate 4.
• The potential for unpleasant side effects and lower compliance in children 4.
• The limited availability of antibiotics in children, which may force treatment based on antimicrobial susceptibility testing 4.

Alternative Treatment Options

Alternative treatment options for H. pylori infection in children include:

• Quadruple therapy with or without bismuth salts 4.
• High-dose amoxicillin as a valid alternative choice in double resistance or second-line treatment 4.
• New dual therapy omeprazole/clarithromycin regimens, although these cannot be recommended for children until additional studies are available 2.