Rescue therapies for Helicobacter pylori in pediatric patients who failed initial treatment

Rescue therapies for Helicobacter pylori in pediatric patients who failed initial treatment

Initial antibiotic susceptibility	Past treatment regimen	Rescue treatment
CLA and MET susceptible	PPI-AMO-CLA	PPI-AMO-MET
CLA and MET susceptible	PPI-AMO-MET	PPI-AMO-CLA
CLA resistant, MET susceptible	PPI-AMO-MET	Treat like double resistance*
CLA susceptible, MET resistant	PPI-AMO-CLA	Treat like double resistance* or consider performing a second endoscopy and use a tailored treatment for 14 days
Primary antimicrobial sensitivity unknown or double resistance	Triple therapy	Consider performing a second endoscopy to assess secondary antimicrobial susceptibility or treat like double resistance*

CLA: clarithromycin; MET: metronidazole; PPI: proton pump inhibitor; AMO: amoxicillin.
* Treatment regimens for double resistance are:

Bismuth-PPI-MET-tetracycline (if ≥8 years), or
Bismuth-PPI-AMO-MET (if <8 years), or
PPI-AMO-MET with high-dose AMO

Where bismuth is available, bismuth-based quadruple therapy is preferred due to better eradication rates compared with high-dose AMO. For dosing, refer to UpToDate table on antibiotic dosing for H. pylori in children.

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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