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Treatment regimens for Helicobacter pylori infection in children

Treatment regimens for Helicobacter pylori infection in children
CLA MET Suggested regimen
Patients without penicillin allergy
Susceptible Susceptible
  • PPI-AMO-CLA
Resistant Susceptible
  • PPI-AMO-MET
Susceptible Resistant
  • PPI-AMO-CLA
Resistant or unknown Resistant or unknown
  • Bismuth-PPI-MET-tetracycline (if ≥8 years), or
  • Bismuth-PPI-AMO-MET (if <8 years), or
  • PPI-AMO-MET with high-dose AMO*
Patients with penicillin allergy
Susceptible Susceptible
  • PPI-MET-CLA
Resistant Susceptible
  • Bismuth-PPI-MET-tetracycline (if ≥8 years)
Susceptible Resistant
  • Bismuth-PPI-CLA-tetracycline (if ≥8 years)
Resistant or unknown Resistant or unknown
  • Bismuth-PPI-MET-tetracycline (if ≥8 years)
The above regimens should be given for 14 days. If sensitivity testing is not available, then the recommended regimen is the same as for CLA and MET resistance. Resistance to CLA should also be assumed if the patient has any prior exposure to this or other macrolide antibiotic. The strain should be assumed to be resistant to MET if the patient has been exposed to this antibiotic within the past few years. For dosing, refer to UpToDate table on antibiotic dosing for H. pylori in children.
CLA: clarithromycin; MET: metronidazole; PPI: proton pump inhibitor; AMO: amoxicillin; H. pylori: Helicobacter pylori.
* Where bismuth is available, bismuth-based quadruple therapy is preferred due to better eradication rates compared with high-dose AMO.
¶ If child is <8 years old and the allergy may be mild, refer to an allergist to determine whether AMO-based treatment is feasible.
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. DOI: 10.1097/MPG.0000000000001594. Copyright © 2017 ESPGHAN and NASPGHAN. Adapted with permission from Wolters Kluwer Health. Unauthorized reproduction of this material is prohibited.
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