{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T19:42:51Z","timestamp":1782502971593,"version":"3.54.5"},"reference-count":56,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,6,1]],"date-time":"2022-06-01T00:00:00Z","timestamp":1654041600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Helicobacter pylori infection can cause gastritis, gastric or duodenal ulcers, mucosa-associated lymphoid tissue lymphoma, gastric cancer, and extra-gastrointestinal manifestations. Ideal treatment should be guided by antibiotic susceptibility testing. However, this is not feasible in many regions, so the treatment generally relies on clinical experience and regional culture sensitivity profiles. We aimed to integrate the treatment of pediatric H. pylori infection through a systematic literature review. Databases including PubMed, Cochrane Library, EMBASE, and Scholar were searched using terms containing (Helicobacter OR Helicobacter pylori OR H. pylori) AND (child OR pediatric) for all relevant manuscripts and guidelines, published from January 2011 to December 2021. The eradication rate for pediatric H. pylori infection was not satisfactory using triple therapy, sequential therapy, concomitant therapy, bismuth-based quadruple therapy, or adjuvant therapy with probiotics as the first-line therapy. Most therapies could not achieve the recommended eradication rate of &gt;90%, which may be attributed to varying regional antibiotic resistance and possible poor children\u2019s compliance. More studies are required to establish a best practice for pediatric H. pylori infection treatment.<\/jats:p>","DOI":"10.3390\/antibiotics11060757","type":"journal-article","created":{"date-parts":[[2022,6,1]],"date-time":"2022-06-01T12:48:31Z","timestamp":1654087711000},"page":"757","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Treatment of Pediatric Helicobacter pylori Infection"],"prefix":"10.3390","volume":"11","author":[{"given":"Hung-Hsiang","family":"Lai","sequence":"first","affiliation":[{"name":"Department of Pediatrics, New Taipei Municipal Tu Cheng Hospital, Chang Gung Memorial Hospital, New Taipei City 23656, Taiwan"},{"name":"Division of Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Wei","family":"Lai","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan"},{"name":"Department of Pediatrics and Liver Research Center, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1056\/NEJMc1006158","article-title":"Helicobacter pylori infection","volume":"363","author":"Vakil","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_2","first-page":"1273","article-title":"Unidentified curved bacilli on gastric epithelium in active chronic gastritis","volume":"1","author":"Warren","year":"1983","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1038\/nrmicro3016","article-title":"Life in the human stomach: Persistence strategies of the bacterial pathogen Helicobacter pylori","volume":"11","author":"Salama","year":"2013","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1111\/apt.14561","article-title":"Systematic review with meta-analysis: The worldwide prevalence of Helicobacter pylori infection","volume":"47","author":"Zamani","year":"2018","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_5","first-page":"1315","article-title":"The updated JSPGHAN guidelines for the management of Helicobacter pylori infection in childhood","volume":"62","author":"Kato","year":"2020","journal-title":"Pediatr. Int. Off. J. Jpn. Pediatr. Soc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e48","DOI":"10.1097\/MPG.0000000000001045","article-title":"Helicobacter pylori Infection and Children\u2019s Growth: An Overview","volume":"62","author":"Dror","year":"2016","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1111\/hel.12141","article-title":"The prevalence of Helicobacter pylori gastritis in newly diagnosed children with inflammatory bowel disease","volume":"19","author":"Roka","year":"2014","journal-title":"Helicobacter"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1111\/jgh.15751","article-title":"Prevalence of Helicobacter pylori infection in China: A systematic review and meta-analysis","volume":"37","author":"Ren","year":"2021","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_9","first-page":"90","article-title":"Paediatric Helicobacter pylori infection in Taiwan: Current status and perspectives","volume":"6","author":"Yeung","year":"2017","journal-title":"Gastroenterology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1097\/MPG.0000000000001594","article-title":"Joint ESPGHAN\/NASPGHAN Guidelines for the Management of Helicobacter pylori in Children and Adolescents (Update 2016)","volume":"64","author":"Jones","year":"2017","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"549","DOI":"10.4161\/gmic.27000","article-title":"What do we know about benefits of H. pylori treatment in childhood?","volume":"4","author":"Sierra","year":"2013","journal-title":"Gut Microbes"},{"key":"ref_12","first-page":"10","article-title":"Advances in the treatment of Helicobacter pylori infection in children","volume":"28","author":"Kalach","year":"2015","journal-title":"Ann. Gastroenterol."},{"key":"ref_13","first-page":"181","article-title":"Helicobacter pylori infection may undergo spontaneous eradication in children: A 2-year follow-up study","volume":"27","author":"Perri","year":"1998","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1097\/MPG.0000000000003184","article-title":"Knowledge Translation Action is Needed to Address Problems in Adherance to Pediatric Helicobacter Consensus Guidelines in Clinical Practice","volume":"73","year":"2021","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1007\/s00431-012-1823-4","article-title":"Clinical practice: Helicobacter pylori infection in childhood","volume":"172","author":"Ertem","year":"2013","journal-title":"Eur. J. Pediatr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1097\/MPG.0000000000002976","article-title":"Low Adherence to Society Guidelines for the Management of Helicobacter pylori among Pediatric Gastroenterologists","volume":"73","author":"Bonilla","year":"2021","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_17","first-page":"98","article-title":"Third-line rescue therapy with Levofloxacin based protocol for H. pylori eradication in children","volume":"3","author":"Eren","year":"2009","journal-title":"Cocuk Enfeksiyon Derg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"417","DOI":"10.5223\/pghn.2019.22.5.417","article-title":"Changes in the Treatment Strategies for Helicobacter pylori Infection in Children and Adolescents in Korea","volume":"22","author":"Jun","year":"2019","journal-title":"Pediatr. Gastroenterol. Hepatol. Nutr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1007\/s12098-015-1878-0","article-title":"Sequential Therapy is Superior to Triple Therapy for Helicobacter pylori Infection in Children: A Meta-Analysis","volume":"83","author":"Huang","year":"2016","journal-title":"Indian J. Pediatr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1111\/j.1365-2036.2012.05229.x","article-title":"Meta-analysis: Sequential therapy for Helicobacter pylori eradication in children","volume":"36","author":"Horvath","year":"2012","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1414","DOI":"10.1053\/j.gastro.2005.09.007","article-title":"Improved efficacy of 10-Day sequential treatment for Helicobacter pylori eradication in children: A randomized trial","volume":"129","author":"Francavilla","year":"2005","journal-title":"Gastroenterology"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Nyssen, O.P., McNicholl, A.G., Megraud, F., Savarino, V., Oderda, G., Fallone, C.A., Fischbach, L., Bazzoli, F., and Gisbert, J.P. (2016). Sequential versus standard triple first-line therapy for Helicobacter pylori eradication. Cochrane Database Syst. Rev.","DOI":"10.1002\/14651858.CD009034.pub2"},{"key":"ref_23","first-page":"E170","article-title":"Sequential versus concomitant therapy for Helicobacter pylori infection in children: A pilot study","volume":"52","author":"Anania","year":"2011","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_24","first-page":"A243","article-title":"Comparison of sequential and triple therapies in the eradication of H. pylori infection in symptomatic children","volume":"56","author":"Hurduc","year":"2007","journal-title":"Gut"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3069","DOI":"10.1038\/ajg.2009.555","article-title":"Sequential therapy or triple therapy for Helicobacter pylori infection: Systematic review and meta-analysis of randomized controlled trials in adults and children","volume":"104","author":"Gatta","year":"2009","journal-title":"Am. J. Gastroenterol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"A104","DOI":"10.1016\/j.dld.2006.07.060","article-title":"A 10-day sequential therapy: New option for Helicobacter pylori eradication in children","volume":"38","author":"Lerro","year":"2006","journal-title":"Dig. Liver Dis."},{"key":"ref_27","first-page":"988","article-title":"Comparison of the efficacy of 10-day sequential therapy and conventional triple therapy for Helicobacter pylori eradication in children","volume":"12","author":"Lu","year":"2010","journal-title":"Zhongguo Dang Dai Er Ke Za Zhi Chin. J. Contemp. Pediatr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1097\/MPG.0b013e318229c769","article-title":"Sequential therapy versus tailored triple therapies for Helicobacter pylori infection in children","volume":"53","author":"Bontems","year":"2011","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.jpeds.2011.01.023","article-title":"Sequential therapy compared with standard triple therapy for Helicobacter pylori eradication in children: A double-blind, randomized, controlled trial","volume":"159","author":"Albrecht","year":"2011","journal-title":"J. Pediatr."},{"key":"ref_30","first-page":"925","article-title":"The efficacy of sequential therapy and standard triple therapy for eradication of Helicobacter pylori infection in children","volume":"29","author":"Liu","year":"2011","journal-title":"J. Clin. Pediatr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"237","DOI":"10.5223\/pghn.2012.15.4.237","article-title":"Efficacy of Proton Pump Inhibitor-based Triple Therapy and Bismuth-based Quadruple Therapy for Helicobacter pylori Eradication in Korean Children","volume":"15","author":"Hong","year":"2012","journal-title":"Pediatr. Gastroenterol. Hepatol. Nutr."},{"key":"ref_32","first-page":"563","article-title":"A 10-day sequential therapy for eradication of Helicobacter pylori infection in children","volume":"50","author":"Huang","year":"2012","journal-title":"Zhonghua Er Ke Za Zhi Chin. J. Pediatr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1007\/s00431-012-1722-8","article-title":"Antibiotic resistance of Helicobacter pylori in pediatric patients\u201410 years\u2019 experience","volume":"171","author":"Hojsak","year":"2012","journal-title":"Eur. J. Pediatr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.1111\/apt.12516","article-title":"Randomised controlled trial: Sequential vs. standard triple therapy for Helicobacter pylori infection in Chinese children-a multicentre, open-labelled study","volume":"38","author":"Huang","year":"2013","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"470","DOI":"10.4103\/0253-7613.117757","article-title":"Effect of sequential versus standard Helicobacter pylori eradication therapy on the associated iron deficiency anemia in children","volume":"45","author":"Murad","year":"2013","journal-title":"Indian J. Pharmacol."},{"key":"ref_36","first-page":"921","article-title":"Effectiveness of sequential v. standard triple therapy for treatment of Helicobacter pylori infection in children in Nairobi, Kenya","volume":"103","author":"Laving","year":"2013","journal-title":"S. Afr. Med. J. Suid-Afrik. Tydskr. Vir Geneeskd."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"382","DOI":"10.4318\/tjg.2013.0575","article-title":"Ornidazole-based sequential therapy is not effective in Helicobacter pylori eradication in children","volume":"24","author":"Baysoy","year":"2013","journal-title":"Turk. J. Gastroenterol. Off. J. Turk. Soc. Gastroenterol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1097\/MEG.0000000000000190","article-title":"Sequential therapy versus standard triple therapy for Helicobacter pylori eradication in children: Any advantage in clarithromycin-resistant strains?","volume":"26","author":"Kutluk","year":"2014","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1111\/hel.12240","article-title":"Sequential Therapy for Helicobacter pylori Infection in Treatment-na\u00efve Children","volume":"21","author":"Schwarzer","year":"2016","journal-title":"Helicobacter"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e12679","DOI":"10.1111\/hel.12679","article-title":"Comparison of four different regimens against Helicobacter pylori as a first-line treatment: A prospective, cross-sectional, comparative, open trial in Chinese children","volume":"25","author":"Zhou","year":"2020","journal-title":"Helicobacter"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"10644","DOI":"10.3748\/wjg.v21.i37.10644","article-title":"Are probiotics useful in Helicobacter pylori eradication?","volume":"21","author":"Homan","year":"2015","journal-title":"World J. Gastroenterol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1128\/AEM.70.1.518-526.2004","article-title":"In vitro and in vivo inhibition of Helicobacter pylori by Lactobacillus casei strain Shirota","volume":"70","author":"Sgouras","year":"2004","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"673","DOI":"10.3748\/wjg.v20.i3.673","article-title":"Probiotics for the treatment of Helicobacter pylori infection in children","volume":"20","author":"Pacifico","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_44","first-page":"79","article-title":"Probiotics for the treatment of pediatric helicobacter pylori infection: A randomized double blind clinical trial","volume":"23","author":"Ahmad","year":"2013","journal-title":"Iran J. Pediatr."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s00431-018-3282-z","article-title":"Efficacy of Lactobacillus-supplemented triple therapy for Helicobacter pylori infection in children: A meta-analysis of randomized controlled trials","volume":"178","author":"Fang","year":"2019","journal-title":"Eur. J. Pediatr."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"188","DOI":"10.7704\/kjhugr.2021.0025","article-title":"Recent changes in the treatment of helicobacter pylori infection in children and adolescents","volume":"21","author":"Seo","year":"2021","journal-title":"Korean J. Helicobacter Up. Gastrointest. Res."},{"key":"ref_47","first-page":"81","article-title":"LOW efficacy of rescue treatments for H. pylori eradication in children after failure of a first sequential regimen","volume":"18","author":"Genis","year":"2013","journal-title":"Helicobacter"},{"key":"ref_48","first-page":"668","article-title":"Low efficacy of second line treatments for H. pylori eradication in children","volume":"68","author":"Kallirroi","year":"2019","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e000679","DOI":"10.1136\/bmjpo-2020-000679","article-title":"Helicobacter pylori infection in children","volume":"4","author":"Escobedo","year":"2020","journal-title":"BMJ Paediatr. Open"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1080\/00365521.2019.1637452","article-title":"Prevalence of clarithromycin-resistant Helicobacter pylori in children living in South of Sweden: A 12-year follow-up","volume":"54","author":"Jansson","year":"2019","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1089\/mdr.2017.0292","article-title":"Antibiotic Resistance of Helicobacter pylori in Iranian Children: A Systematic Review and Meta-Analysis","volume":"24","author":"Vaez","year":"2018","journal-title":"Microb. Drug Resist."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1111\/j.1523-5378.2012.00950.x","article-title":"Eradication of Helicobacter pylori in children in Vietnam in relation to antibiotic resistance","volume":"17","author":"Nguyen","year":"2012","journal-title":"Helicobacter"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1053\/j.gastro.2018.07.007","article-title":"Prevalence of Antibiotic Resistance in Helicobacter pylori: A Systematic Review and Meta-analysis in World Health Organization Regions","volume":"155","author":"Savoldi","year":"2018","journal-title":"Gastroenterology"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e12633","DOI":"10.1111\/hel.12633","article-title":"Increasing antimicrobial resistance to clarithromycin and metronidazole in pediatric Helicobacter pylori infection in southern Taiwan: A comparison between two decades","volume":"24","author":"Lu","year":"2019","journal-title":"Helicobacter"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1099\/jmm.0.080507-0","article-title":"Analysis of intra-familial transmission of Helicobacter pylori in Japanese families","volume":"64","author":"Osaki","year":"2015","journal-title":"J. Med. Microbiol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"e12793","DOI":"10.1111\/hel.12793","article-title":"Whole family-based Helicobacter pylori eradication is a superior strategy to single-infected patient treatment approach: A systematic review and meta-analysis","volume":"26","author":"Zhao","year":"2021","journal-title":"Helicobacter"}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/11\/6\/757\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:23:27Z","timestamp":1760138607000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/11\/6\/757"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,1]]},"references-count":56,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["antibiotics11060757"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics11060757","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,1]]}}}