Proton Pump Inhibitor Options for H. pylori Therapy

Patient Population: Pediatric
Weight PPI Dose Equivalents 
15 to 24 kg 

Esomeprazole (Nexium) 20 mg enterally twice daily 

OR 

Lansoprazole (Prevacid) 15 mg enterally twice daily 

OR  

Omeprazole (Prilosec) 20 mg enterally twice daily 

OR 

Pantoprazole (Protonix) 20 mg enterally twice daily 

25 to 34 kg 

Esomeprazole (Nexium) 30 mg enterally twice daily 

OR 

Lansoprazole (Prevacid) 30 mg enterally twice daily 

OR 

Omeprazole (Prilosec) 30 mg enterally twice daily 

OR 

Pantoprazole (Protonix) 40 mg enterally twice daily 

> 35 kg 

Esomeprazole (Nexium) 40 mg enterally twice daily 

OR 

Lansoprazole (Prevacid) 30 mg enterally 2 to 3 times daily 

OR 

Omeprazole (Prilosec) 40 mg enterally twice daily 

OR 

Pantoprazole (Protonix) 40 mg or 80 mg enterally twice daily 

Weight PPI Dose Equivalents 
6 to < 10 kg 

Rabeprazole (Aciphex) 10 mg enterally twice daily 

10 to < 30 kg 

Rabeprazole (Aciphex) 15 mg enterally twice daily 

≥ 30 kg 

Rabeprazole (Aciphex) 20 mg enterally twice daily 

Note: Esomeprazole (Nexium®) and rabeprazole (Aciphex®) are less susceptible to degradation by rapid metabolizers with CYP2C19 genetic polymorphism, and therefore, may be preferred when available. 

Rapid metabolizers are more frequent in white individuals (56%–81%) compared to individuals of Asian descent. 

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.