Joint ESPGHAN/NASPGHAN guidelines (NL Jones et al. JPGN 2017; 64: 991-1003) have been published. Overall, these guidelines cover a great deal of information. It is interesting that these guidelines provide some conflicting advice with recommendations for adults.
- Some recommendations:
The authors recommend against diagnostic testing H pylori in children with functional abdominal pain
- The authors recommend against using antibody-based tests from blood, urine, or saliva.
- The authors recommend noninvasive testing for H pylori when investigating chronic immune thrombocytopenic purpura (ITP)
- First line therapy recommendations if sensitivity is unknown: High-dose PPI-Amoxicillin-Metronidazole for 14 days OR Bismuth-based quadruple therapy (in children less than 8 years, quadruple therapy would be bismuth, PPI, amoxicillin and metronidazole; in older children it is recommended to substitute tetracycline for amoxicillin). Specific dosing is given in this report (Table 3 and Table 4)
- The authors recommend assessing for infection eradication at least 4 weeks after completion of therapy
My take: I favor quadruple therapy for most patients (see adult guidelines below) until sensitivities can be more easily obtained. If you know of a reliable lab to obtain culture sensitivities, please let me know.
Related blog posts:
- Quadruple Therapy for Helicobacter Pylori Favored in Toronto Guidelines
- ACG Guideline for Helicobacter Pylori | gutsandgrowth
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