H. pylori Eradication Tool

Select different tabs to see different information about the dose regimen or select the first option to go through the H. pylori eradication tool.
To see ESPGHAN/NASPGHAN guidelines PDF click here.
To access educational material for parenteral guidance click here.


Please select the corresponding answer to get the dosing regimen calculated.

Based on the answer, the recommended options for first line therapy for H. pylori is:

Please input the child's weight to calculate the dosing regimen.

kg

Dosing Regimen

Drug Morning dose Evening dose
PPI
Amoxicillin
Amoxicillin (high dose)
Clarithromycin
Metronidazole
Bismuth subsalicilate (US market) <10 years 262mg QID
>10 years 524 mg QID

Standard dosing regimen for treatment naive patients.

Drug Bodyweight range Morning dose Evening dose
PPI 15 to 24 kg 20mg 20mg
25 to 34 kg 30mg 30mg
>35 kg 40mg 40mg
Amoxicillin 15 to 24 kg 500mg 500mg
25 to 34 kg 750mg 750mg
>35 kg 1000mg 1000mg
Clarithromycin 15 to 24 kg 250mg 250mg
25 to 34 kg 500mg 250mg
>35 kg 500mg 500mg
Metronidazole 15 to 24 kg 250mg 250mg
25 to 34 kg 500mg 250mg
>35 kg 500mg 500mg
Bismuth subsalicilate (US market) <10 years 262mg QID
>10 years 524mg QID

High Dosing Regimen for Amoxicillin

Bodyweight range Morning dose Evening dose
15 to 24 kg 750mg 750mg
25 to 34 kg 1000mg 1000mg
>35 kg 1500mg 1500mg

Rescue therapies in pediatric patients who failed therapy.

Initial Antibiotic Susceptibility Past treatment- Regimen Rescue Treatment
Clarithromycin and metronidazole susceptible Triple therapy using amoxicillin and clarithromycin
Triple therapy using amoxicillin and metronidazole
Triple therapy using amoxicillin and metronidazole
Triple therapy using amoxicillin and clarithromycin
Clarithromycin and metronidazole susceptible Sequential therapy Consider performing a second endoscopy and use a tailored treatment for 14d or treat like double resistance.
Clarithromycin resistant Triple therapy using metronidazole Treat like double resistance
Metronidazole resistant Triple therapy using clarithromycin Consider performing a second endoscopy and use a tailored treatment for 14 days or treat like double resistance.
Primary antimicrobial susceptibility unknown Triple therapy or sequential therapy Consider performing a second endoscopy to assess secondary antimicrobial susceptibility or treat like double resistance.

Synopsis of ESPGHAN/NASPGHAN guidelines recommendations.

1. We recommend that the primary goal of clinical investigation of gastrointestinal symptoms should be to determine the underlying cause of the symptoms and not solely the presence of H pylori infection.

2a. We recommend that during endoscopy additional biopsies for RUT and culture should only be taken if treatment is likely to be offered if infection is confirmed.

2b. We suggest that if H pylori infection is an incidental finding at endoscopy, treatment may be considered after careful discussion of the risks and benefits of H pylori treatment with the patient/parents.

2c. We recommend against a ‘‘test and treat’’ strategy for H pylori infection in children.

3. We recommend that testing for H pylori be performed in children with gastric or duodenal ulcers. If H pylori infection is identified then treatment should be advised and eradication be confirmed.

4. We recommend against diagnostic testing for H pylori infection in children with functional abdominal pain.

5a. We recommend against diagnostic testing for H pylori infection as part of the initial investigation in children with iron deficiency anemia.

5b. We suggest that in children with refractory IDA in which other causes have been ruled out, testing for H pylori during upper endoscopy may be considered.

6. We suggest that noninvasive diagnostic testing for H pylori infection may be considered when investigating causes of chronic immune thrombocytopenic purpura (ITP).

7. We recommend against diagnostic testing for H pylori infection when investigating causes of short stature.

8. We recommend that before testing for H pylori, waiting at least 2 weeks after stopping proton pump inhibitor (PPI) and 4 weeks after stopping antibiotics.

9a. We recommend that the diagnosis of H pylori infection should be based on either (a) histopathology (H pylori–positive gastritis) plus at least 1 other positive biopsy-based test or (b) positive culture.

9b. We recommend that for the diagnosis of H pylori infection at upper gastrointestinal endoscopy, at least 6 gastric biopsies be obtained.

10. We recommend against using antibody-based tests (IgG, IgA) for H pylori in serum, whole blood, urine, and saliva in the clinical setting.

11. We recommend that antimicrobial sensitivity be obtained for the infecting H pylori strain (s), and eradication therapy tailored accordingly.

12. We recommend that the effectiveness of first-line therapy be evaluated in national/regional centers.

13. We recommend that the physician explain to the patient/family the importance of adherence to the anti–H pylori therapy to enhance successful eradication.

14. We recommend first-line therapy for H pylori infection as listed in Table 2.

15. We recommend that the outcome of anti–H pylori therapy be assessed at least 4 weeks after completion of therapy using one of the following tests. (a) The 13C-urea breath (13C-UBT) test or (b) a 2-step monoclonal stool antigen test.

16. We recommend that when H pylori treatment fails, rescue therapy should be individualized considering antibiotic susceptibility, the age of the child, and available antimicrobial options.