Several factors including long-term eradication of the organism, cost, compliance, and adverse event profile should be considered for treating H. pylori
infection in pediatric patients. Triple
therapy with
bismuth,
tetracycline, and
metronidazole is considered the gold standard for adult patients; however,
tetracyclines are not recommended in children younger than 8 years due to the potential for
tooth discoloration and alterations in bone growth. Dual and shorter
duration of therapy should be evaluated in children with H. pylori. The new dual
therapy omeprazole/
clarithromycin regimens approved by the Food and Drug Administration for adults may be considered as an alternative for children when concerns include the use of
salicylates or
allergy to
beta-lactams. Although the dosage of
omeprazole in pediatric patients has not been established (no pediatric formulation exists),
clarithromycin is available for use in pediatric patients. However, these drugs cannot be recommended for children with H. pylori until additional studies in this population are available. Based on the available data, aminopenicillin/
bismuth or aminopenicillin/
tinidazole combinations appear to be effective in eradicating H. pylori in children.
Amoxicillin 50 mg/kg/d plus
bismuth subsalicylate (< 10 y, 262 mg; > 10 y, 525 mg qid) or
bismuth subcitrate (< 12 y, 120 mg; > 12 y, 240 mg bid) can be used for 6 weeks. The
bismuth dosages represented above were those used in various studies. It should be realized, however, that a definitive dosage of
bismuth subsalicylate for children in the treatment of H. pylori has not been established. The adult dosage of
bismuth subsalicylate for the eradication of H. pylori is the same as that used for prophylaxis in
diarrhea (525 mg qid). When dosage of this agent is unknown (particularly for the treatment of very young children), the use of established dosages for prophylaxis in
diarrhea may be considered for treating H. pylori. Additionally,
bismuth subsalicylate should be used with caution in children with suspected
viral infections (i.e., to prevent
Reye's syndrome) or those receiving concurrent
therapy with interacting drugs. If available,
tinidazole 20 mg/kg/d can be used with
amoxicillin 50 mg/kg/d for 6 weeks to treat children infected with H. pylori.