Initial treatment regimens for Helicobacter pylori infection in children

Initial treatment regimens for Helicobacter pylori infection in children

Antimicrobial susceptibility tests	Options for treatment regimen
Unknown	Bismuth-PPI-MET-TET (if ≥8 years), or Bismuth-PPI-AMO-MET (if <8 years), or PPI-AMO-MET with high-dose AMO* If penicillin allergy: Bismuth-PPI-MET-TET (if ≥8 years)^¶
Test results known
CLA susceptible, MET susceptible	PPI-AMO-CLA If penicillin allergy: PPI-MET-CLA
CLA resistant, MET susceptible	PPI-AMO-MET or Bismuth-PPI-AMO-MET* or Bismuth-PPI-MET-TET* (if ≥8 years) If penicillin allergy: Bismuth-PPI-MET-TET (if ≥8 years)^¶
CLA susceptible, MET resistant	PPI-AMO-CLA or Bismuth-PPI-AMO-CLA* or Bismuth-PPI-CLA-TET* (if ≥8 years) If penicillin allergy: Bismuth-PPI-CLA-TET (if ≥8 years)^¶
CLA resistant, MET resistant	Bismuth-PPI-MET-TET (if ≥8 years), or Bismuth-PPI-AMO-MET (if <8 years), or PPI-AMO-MET with high-dose AMO* If penicillin allergy: Bismuth-PPI-MET-TET (if ≥8 years)^¶

The above regimens should be given for 14 days. If antibiotic susceptibility testing is not available, then the regimen is the same as for dual CLA and MET resistance. For dosing, refer to UpToDate table on antibiotic dosing for H. pylori in children.

PPI: proton pump inhibitor; MET: metronidazole; TET: tetracycline; AMO: amoxicillin; CLA: clarithromycin; H. pylori: Helicobacter pylori.

* Where bismuth is available, bismuth-based quadruple therapy is preferred due to better eradication rates compared with triple therapy (including triple therapy with high-dose AMO). We use bismuth-based regimens when indicated. In the United States, bismuth is available only as bismuth subsalicylate, so we avoid it if the child has any flu-like illness because of theoretical concerns about Reye syndrome due to the subsalicylate component.

¶ If child is <8 years old and the allergy might be mild, refer to an allergist to determine whether AMO-based treatment is feasible.

Adapted from: Jones NL, Koletzko S, Goodman K, et al. Joint ESPGHAN/NASPGHAN Guidelines for the Management of Helicobacter pylori in Children and Adolescents (Update 2016). J Pediatr Gastroenterol Nutr 2017; 64:991.

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Initial treatment regimens for Helicobacter pylori infection in children