Clinical context (Treat only when clear indication and eradication is planned · minimize empiric therapy · choose regimen based on antimicrobial susceptibility testing when available (ESPGHAN/NASPGHAN 2023 update))
Max 40 mg/dose · Max 80 mg/day · Duration: 14 days · Use clarithromycin-based triple therapy ONLY when strain is clarithromycin-susceptible · give PPI 15–30 min before meals
Enter weight on Kids to calculate doses
Amoxicillin • p.o. • 25–25 mg/kg/dose • 2×/day
Max 1000 mg/dose · Duration: 14 days · Standard-dose in clarithromycin-susceptible triple therapy
Max 40 mg/dose · Max 80 mg/day · Duration: 14 days · Preferred when clarithromycin resistance is present or suspected; use high-dose amoxicillin per ESPGHAN/NASPGHAN
• Susceptibility-guided therapy is preferred whenever available — obtain culture or molecular resistance testing from gastric biopsy specimens (ESPGHAN/NASPGHAN 2023 update).
• Avoid empiric clarithromycin-containing regimens when susceptibility is unknown due to rising resistance and lower eradication rates (ESPGHAN/NASPGHAN 2023 update).
• PPI + amoxicillin + metronidazole: preferred when clarithromycin resistance is present/suspected or when susceptibility is unknown and bismuth regimen is not feasible (ESPGHAN/NASPGHAN eradication tool).
• Bismuth-based quadruple therapy: empiric first-line option when susceptibility is unavailable; also useful after failure of clarithromycin-based triple therapy (ESPGHAN/NASPGHAN 2023 update).
• After treatment failure: do not reuse clarithromycin or metronidazole without susceptibility data; select rescue therapy based on prior exposure and AST; consider specialist referral (pediatric GI/ID) (ESPGHAN/NASPGHAN).
Max 1000 mg/dose · Duration: 14 days · High-dose amoxicillin (75 mg/kg/day) for susceptibility-unknown or clarithromycin-resistant strains
Enter weight on Kids to calculate doses
Metronidazole • p.o. • 10–10 mg/kg/dose • 2×/day
Max 500 mg/dose · Max 1000 mg/day · Duration: 14 days · Common pediatric eradication dosing (20 mg/kg/day total) — tailor to local guideline tool if available
Enter weight on Kids to calculate doses
Clinical notes
• Indications for eradication therapy: peptic ulcer disease (gastric or duodenal) and/or erosive gastritis with confirmed H. pylori; incidental infection may be treated after discussing risks/benefits — do NOT use a "test-and-treat" strategy for functional abdominal pain in children (ESPGHAN/NASPGHAN).
• Antimicrobial susceptibility testing should be performed whenever possible (culture or molecular resistance testing from gastric biopsy) and should guide therapy selection; minimize empiric therapy (ESPGHAN/NASPGHAN 2023 update).
• If susceptibility is unknown, avoid clarithromycin-containing regimens; prefer bismuth-based quadruple therapy or PPI + high-dose amoxicillin + metronidazole for 14 days (ESPGHAN/NASPGHAN).
• Test of cure: urea breath test or stool antigen test ≥4 weeks after finishing antibiotics (and bismuth) and ≥2 weeks after stopping PPI to avoid false negatives (ESPGHAN/NASPGHAN).
• After treatment failure: confirm adherence, ensure correct dosing/duration, and select rescue therapy based on AST and prior antibiotics (avoid reusing clarithromycin/metronidazole empirically); consider bismuth regimen or other specialist-guided rescue options in adolescents (ESPGHAN/NASPGHAN).
• ESPGHAN / NASPGHAN — Updated joint guidelines for management of H. pylori in children and adolescents (2024)
