Helicobacter pylori Infection

Patient Population: Pediatric


H. pylori testing should be limited to patients with a high likelihood of H. pylori-related disease. This includes patients with peptic ulcer disease or mucosa-associated lymphoid tissue (MALT) lymphoma, and selected patients with nodular gastropathy, chronic immune thrombocytopenia, refractory iron deficiency anemia, or family history of gastric cancer. 

Current guidelines for H. pylori in children (ESPGHAN/NASPGHAN, linked below) recommend that the initial diagnosis be established based on: 

a) positive histopathology for H. pylori gastritis from gastric biopsy plus at least 1 other positive biopsy-based test OR  

b) a positive culture

And not with a non-invasive test such as stool antigen.  

However, some experts would consider use of non-invasive tests (see below under follow-up) if endoscopy is not otherwise indicated for patient management.  

Pediatric testing criteria are narrower than corresponding adult criteria and the decision to utilize non-invasive testing in pediatric patients or to treat a patient with a positive non-invasive test is controversial. Individual risk factors (country of origin, family history, anticipated risk for complications and ability to complete treatment) should be taken into consideration.  

Testing of patients with functional abdominal pain or gastroesophageal reflux disease is not recommended.  

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

Follow up

Outcome of H. pylori therapy should be assessed at least 4 weeks after completion of therapy using one of the following tests: 

(a) urea breath test OR 

(b) stool antigen test 

Condition Major Pathogens  First-choice Therapy Alternative Therapy Comments

Helicobacter pylori infection, initial treatment, susceptibilities unknown 

Refer to ESPGHAN/ NASPGHAN guidelines (linked below) for treatment based on susceptibilities if they are available  

Helicobacter pylori 


Options for proton pump inhibitor (PPI)

Omeprazole (Prilosec)  


Esomeprazole (Nexium)  

Weight 15-24 kg: 20 mg enterally bid 

Weight 25-34 kg: 30 mg enterally bid 

Weight > 35 kg: 40 mg enterally bid 



Weight 15-24 kg: 15 mg enterally bid 

Weight 25-34 kg: 30 mg enterally bid 

Weight > 35 kg: 30 mg enterally bid or tid 

PPI dose equivalents (follow link for options) 

PPI (from second column)  



Weight 15-24 kg: 750 mg enterally bid  

Weight 25-34 kg: 1000 mg enterally bid  

Weight > 35 kg: 1500 mg enterally bid  



Weight 15-24 kg: 250 mg enterally bid  

Weight 25-34 kg: 500 mg AM and 250 mg enterally PM 

Weight > 35 kg: 500 mg enterally bid  


Penicillin allergy with higher risk for allergic reaction

Refer to guidelines below for alternative treatment based on susceptibilities or consult ID/ASP for guidance 

Bismuth-based or quadruple therapy are alternatives included in ESPGHAN/NASPGHAN guidelines (see below reference). 

Treatment failure should be addressed with individualized rescue therapy considering antibiotic susceptibility, the age of the child, and available antimicrobial options; patients with treatment failure should be managed in consultation with GI 

GI consult recommended for patients with positive H. pylori testing to consider next steps in diagnosis and treatment  

Duration: 14 days 

Patient and family should be counseled about the importance of adherence to the anti – H. pylori therapy to enhance successful eradication 

Pediatric Empiric Antimicrobial Therapy Guidelines

This is a subsection of the UCSF Benioff Children’s Hospitals Empiric Antimicrobial Therapy Guidelines, developed by the Pediatric Antimicrobial Stewardship Programs at each campus to inform initial selection of empiric antimicrobial therapy for children at the UCSF Benioff Children’s Hospitals and affiliated outpatient sites. 

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. Durations provided are usual recommendations for patients who are responding appropriately to therapy. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP) at the campus where your patient is receiving care.  

For questions or feedback about these guidelines, please email primary content owners, Rachel Wattier, Pediatric ASP Medical Director at BCH SF and Prachi Singh, Pediatric ASP Medical Director at BCH OAK. 

The content of these guidelines was updated in July 2021. See Summary and Rationale for Changes (password login to Box needed) for detailed explanations of the content changes.