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Guidelines for the treatment of Helicobacter pylori in the pediatric population
D M Robinson1, S M Abdel-Rahman, M C Nahata
1College of Pharmacy, Ohio State University, Columbus 43210, USA.
Insights
Treating H. pylori in children requires careful consideration of factors like cost and safety. Amoxicillin combined with bismuth or tinidazole shows effectiveness, but definitive pediatric dosages are still needed.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Pharmacology
Background:
- Helicobacter pylori (H. pylori) infection management in children presents unique challenges.
- Standard adult therapies, like triple therapy with bismuth, tetracycline, and metronidazole, have limitations in pediatric populations.
- Tetracyclines are contraindicated in children under 8 due to potential adverse effects on tooth and bone development.
Purpose of the Study:
- To review current considerations for H. pylori eradication in pediatric patients.
- To evaluate alternative therapeutic regimens suitable for children.
- To highlight the need for further research on pediatric H. pylori treatment.
Main Methods:
- Review of existing literature on H. pylori treatment in children.
- Analysis of safety profiles and efficacy of different drug combinations.
- Comparison of adult treatment guidelines with pediatric applicability.
Main Results:
- Amoxicillin combined with bismuth or tinidazole demonstrates efficacy in H. pylori eradication in children.
- Specific bismuth dosages for pediatric H. pylori treatment are not definitively established.
- Newer dual therapies approved for adults, such as omeprazole/clarithromycin, require further pediatric investigation.
Conclusions:
- Amoxicillin/bismuth or amoxicillin/tinidazole combinations are viable options for pediatric H. pylori treatment.
- Careful consideration of drug dosages and safety, particularly regarding bismuth and potential interactions, is crucial.
- Further clinical studies are essential to establish definitive treatment protocols for H. pylori in children.
Abstract:
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.