A prospective trial of lansoprazole triple therapy for pediatric Helicobacter pylori infection
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Updated: Oct 17, 2026
Gastric Mucosa Quantitative Polymerase Chain Reaction Analysis for Detecting Helicobacter pylori and Antibiotic Resistance
Published on: March 7, 2025
H Shashidhar1, J Peters, C H Lin
1Division of Pediatric Gastroenterology and Nutrition, Children's Hospital of Michigan, Wayne State University, Detroit 48201, USA.
Insights
Triple therapy for Helicobacter pylori infection in children showed symptom improvement but only 56% eradication. Further research is needed for pediatric H. pylori treatment efficacy.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Triple therapy is standard for adult Helicobacter pylori (H. pylori) infections.
- Pediatric H. pylori treatment data is limited.
- This study evaluated a lansoprazole, clarithromycin, and amoxicillin regimen in children.
Purpose of the Study:
- To assess the safety and efficacy of triple therapy for H. pylori infection in symptomatic children.
- To evaluate symptom improvement, histologic changes, and bacterial eradication rates.
Main Methods:
- A prospective, open-label trial involving 32 children with H. pylori gastritis.
- Treatment included lansoprazole, amoxicillin, and clarithromycin for 2 weeks.
- Endoscopic biopsies and symptom questionnaires assessed outcomes pre- and post-treatment.
Main Results:
- H. pylori eradication was achieved in 15 out of 28 children (54%).
- Significant improvement in gastritis histology and symptoms (vomiting, pain, diarrhea) was observed.
- Minor adverse effects were reported in 25% of pediatric patients.
Conclusions:
- Triple therapy improved symptoms and histologic findings in pediatric H. pylori gastritis.
- The eradication rate of 56% suggests potential limitations in this regimen for children.
- Further investigation into optimal pediatric H. pylori eradication strategies is warranted.
Background:
Triple therapy with a proton-pump inhibitor and two antibiotics is widely used in the treatment of Helicobacter pylori infection in adults. Experience with such therapy in the pediatric population is limited. This was a prospective, nonrandomized, open-label trial to evaluate safety and efficacy of a combination of lansoprazole, clarithromycin, and amoxicillin in symptomatic children with H. pylori infection.
Methods:
Children with H. pylori gastritis diagnosed by endoscopy performed for persistent nausea, vomiting, recurrent abdominal pain, and diarrhea with consistent histology were treated with the regimen of 0.45 mg/kg per day lansoprazole divided into two doses (maximum dose, 15 mg twice daily), amoxicillin 40 mg/kg per day in two doses (maximum dose, 1.0 g twice daily), and 250 mg clarithromycin twice daily (<10 years old) or 500 mg twice daily (>10 years old) for 2 weeks. Pre- and posttreatment endoscopic biopsy specimens were graded for the severity of gastritis and H. pylori density by a blinded pathologist. A questionnaire for assessing the severity of symptoms at the time of initial and second endoscopy were completed by patient and/or parent.
Results:
Thirty-two children (age range, 1-25 years; mean age, 11 years; 19 females, 13 males) were treated with this regimen during an 18-month period. H. pylori organisms with varying grades of gastritis were present in tissue specimens of all patients. Only 28 children had follow-up endoscopy, which showed eradication of H. pylori in 15 (54%) children. Histologic symptoms of gastritis improved after therapy in the whole group. Overall, symptoms of vomiting, abdominal pain, diarrhea, anorexia, and halitosis significantly improved (P < 0.05). Minor adverse effects of therapy occurred in 25% of patients.
Conclusions:
Symptoms, histologic, and endoscopic findings improved after triple therapy in children with H. pylori gastritis; however, eradication of bacteria was achieved in only 56% of children.
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