Pediatric Helicobacter Pylori Infection Medication

Updated: Nov 16, 2018
  • Author: Mutaz I Sultan, MBChB, MD; Chief Editor: Carmen Cuffari, MD  more...
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Medication

Antibiotics, beta-lactams

Class Summary

The beta-lactam used to treat patients with H pylori infection is stable in an acid environment, binds to proteins within bacterial cell walls, induces direct wall lysis, and inhibits cell-wall synthesis.

Amoxicillin (Amoxil, Polymox, Trimox, Wymox)

Bactericidal activity against H pylori. Available as gtt 50 mg/mL; susp 125, 200, 250, or 400 mg/5 mL; cap 250 or 500 mg; and chewable tab 125, 200, 250, or 400 mg.

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Antibiotics, macrolides

Class Summary

The macrolide used in the treatment of H pylori infection is stable in the gastric environment, enters the bacterial cell, binds to receptors on the ribosomal subunits, and inhibits bacterial protein synthesis.

Clarithromycin (Biaxin)

Provides bacteriocidal activity against H pylori with antimicrobial spectrum similar to that of erythromycin but more stable in acid environment and has fewer adverse GI effects. Available as granules for susp 125 or 250 mg/5 mL and film tab: 250 or 500 mg.

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Antibiotics, antiprotozoals

Class Summary

This antibiotic, used in the treatment of patients with H pylori infection, produces intracellular products that damage bacterial DNA.

Metronidazole (Flagyl, Protostat)

Metronidazole diffuses into all tissues well, is stable in an acidic pH environment, and provides bactericidal activity against H pylori. Available as compounded extemporaneous susp 50 or 100 mg/5 mL, tab 250 or 500 mg, and cap 375 mg.

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Antibiotics, tetracyclines

Class Summary

Tetracyclines bind to ribosomal subunits and inhibit protein synthesis of susceptible bacteria. Use in pediatric patients should be restricted to children in whom other antibiotic regimens fail.

Tetracycline HCL (Achromycin, Sumycin, Terramycin)

Bacteriostatic, but may be bactericidal at high concentrations. Available as tab 250 or 500 mg, cap 100, 250, or 500 mg, and susp 125 mg/5 mL.

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H2-receptor antagonists

Class Summary

Receptors for H2 are located on the acid-producing parietal cells. Blocking histamine action suppresses gastric acid secretion.

Ranitidine (Zantac)

H2 antagonists prescribed for 8 wk, when most non– H pylori -associated ulcers heal. H2 blockers have no antibacterial effect; therefore, must be used with antibiotics to eradicate H pylori. Available as syr 15 mg/mL, tab 75, 150, or 300 mg; and effervescent tab 150 mg.

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PPIs

Class Summary

This class of drugs, which includes acid inhibitors more potent than the H2-receptor antagonists, blocks gastric acid secretion at the proton (Na+/H+ ATPase) pump, the final common pathway of secretion. This class is recommended as part of a drug regimen in symptomatic patients with H pylori infection. Similar to H2-receptor blockade, proton pump inhibitor (PPI) therapy alone does not eradicate H pylori infection; however, bacteriostatic activity against H pylori occurs.

Omeprazole (Prilosec)

Potent blocker of gastric acid. Best administered just before first meal of day. Enteric-coated granules in cap ensure appropriate bioavailability. For children unable to swallow intact cap, open and place granules in acidic substance (eg, apple sauce or apple juice), which is preferred to administering less bioavailable susp. Available as SR cap 10 or 20 mg and granules for PO susp 20 or 40 mg/packet.

Lansoprazole (Prevacid)

Potent blocker of gastric acid. Best administered just before first meal of day. Enteric-coated granules in the cap ensure appropriate bioavailability. For children unable to swallow intact cap, open and place granules in acidic substance (eg, apple sauce or apple juice), which is preferred to administering less bioavailable susp. Available as delayed-release cap 15 or 30 mg and granules for PO susp 15 mg or 30 mg/packet.

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Bismuths

Class Summary

Bismuth subsalicylate and bismuth subcitrate have complementary effects with most antimicrobials. Bismuth disrupts bacterial cell walls. Bismuth is particularly effective in lysing the cell wall of the organism when the organism is close to the gastric epithelium and relatively inaccessible to most antimicrobial agents.

Bismuth subsalicylate (Pepto-Bismol)

Lyses bacterial cell walls, prevents organism adhesion to epithelium, and inhibits urease.

Available as (subsalicylate) chewable tab 262 mg and liquid 262 mg or 525 mg/15 mL.

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