Initial therapy for Helicobacter pylori eradication in children

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

* Because antibiotic resistance is common, selection of an appropriate regimen should be made based on antibiotic susceptibility testing for the individual patient, if at all possible. Susceptibility testing is particularly important for children with persistent H. pylori infection after an initial attempt at eradication. If susceptibility testing is not available ("unknown" pathways above), use the same regimen as for CLA and MET resistance.

¶ Bismuth-based quadruple therapy consists of bismuth-PPI-AMO-MET (for age <8 years) or bismuth-PPI-MET-TET (for age ≥8 years). 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.