Pediatric Guidelines: Gastrointestinal Infections - Helicobacter pylori Infection

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Condition Major Pathogens First Choice Therapy Alternative Therapy Comments
Helicobacter pylori infection Helicobacter pylori

PPI (from second column) 

AND

Amoxicillin 25mg/kg/dose PO BID (max 1000mg/dose)

AND 

One of the following:

Clarithromycin* 10mg/kg/dose PO BID (max 500mg/dose)

OR 

Metronidazole 10mg/kg/dose PO BID (max 500mg/dose)

Duration: 10-14 days

Sequential therapy:

PPI (from second column)

AND 

Amoxicillin 25mg/kg/dose PO BID (max 1000mg/dose)

For 5 days, THEN:

Stop Amoxicillin

Continue PPI

AND 

Clarithromycin* 10mg/kg/dose PO BID (max 500mg/dose)

AND 

Metronidazole 10mg/kg/dose PO BID (max 500mg/dose)

For 5 days (total duration 10 days for entire regimen)

GI consult recommended. Current guidelines for H. pylori in children recommend that the initial diagnosis be established based on 1) positive histopathology from gastric biopsy and a positve rapid urease test OR 2) a positive culture. Testing of patients with functional abdominal pain is not recommended. 

Serology is not considered a reliable diagnostic test due to low sensitivity and specificity. 

Stool antigen test may be used to reliably determine whether H. pylori has been eradicated. Testing to confirm eradication is recommended 4-8 weeks after completion of therapy. 

*Check for Clarithromycin-based drug interactions before initiating treatment

Options for proton pump inhibitor (PPI):

Omeprazole (Prilosec) 0.5-1mg/kg/dose PO BID (max 20mg/dose)

OR

Lansoprazole (Prevacid) 0.5-1mg/kg/dose PO BID (max 30mg/dose)

OR 

Esomeprazole (Nexium) 0.5-1mg/kg/dose PO BID (max 20mg/dose)

Reference: Koletzko, S, et al. Evidence-based guidelines from ESPGHAN and NASPGHAN for Helicobacter pylori infection in childrenJ Pediatr Gastroenterol Nutr 2011;53:230-243.

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP).