From the Guidelines
The recommended treatment regimen for Helicobacter pylori infection in pediatric patients is a 14-day course of clarithromycin triple therapy, consisting of a proton pump inhibitor (PPI), clarithromycin, and amoxicillin or metronidazole, as outlined in recent guidelines 1. This regimen is based on the most recent and highest quality study, which compiles data from multiple national and multinational H. pylori management guidelines 1. The clarithromycin triple therapy regimen typically includes a PPI such as pantoprazole or lansoprazole, combined with clarithromycin and amoxicillin or metronidazole. Some key points to consider when treating H. pylori infection in pediatric patients include:
- The importance of using a standard dose of PPI, unless high-dose is specifically stated, with optimal dosing 30 minutes prior to eating or drinking on an empty stomach, without concomitant use of other anti-acids 1
- The use of amoxicillin or metronidazole as the second antibiotic, with metronidazole being a suitable alternative for penicillin-allergic patients
- The potential need for quadruple therapy in areas with high clarithromycin resistance or after failed initial therapy, which may include the addition of bismuth subsalicylate to the regimen
- 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 2 weeks after stopping PPI therapy 1. Overall, the goal of treatment is to eradicate H. pylori infection and prevent complications such as peptic ulcer disease, gastritis, and potential long-term risks including gastric cancer, while also ensuring treatment adherence and educating parents about the importance of completing the full course of medication.
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 drug resistance.
- 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.
- Triple therapy with a proton-pump inhibitor and two antibiotics, such as lansoprazole, clarithromycin, and amoxicillin, has been shown to be effective in some studies 3.
- A two-week regimen of a PPI, clarithromycin, and amoxicillin or metronidazole has been recommended as a first-line treatment in some guidelines 4, 5.
Considerations for Treatment
When selecting a treatment regimen for pediatric patients with H. pylori infection, several factors should be considered, including:
- Age and weight of the patient
- Presence of drug resistance
- Severity of symptoms
- Potential side effects of treatment
- Availability of pediatric formulations of medications 2, 4, 5, 3, 6.
Proton Pump Inhibitors (PPIs) in Treatment
PPIs, such as lansoprazole, are an integral part of triple therapy for H. pylori eradication in children with gastroduodenal disease 6.
- PPIs have been shown to be effective in combination with antibiotics, such as clarithromycin and amoxicillin, in eradicating H. pylori in children 3, 6.
- However, individual variability in drug response among pediatric patients is common, and genetic, developmental, and disease-related factors may affect the efficacy of PPIs 6.