Helicobacter pylori Eradication Using Empirical Therapy in Symptomatic Pediatric Patients: A Multicenter Real-World Study From Colombia.

Background Helicobacter pylori (Hp) infection remains a major public health challenge in Colombia, a region with a high incidence of gastric cancer. Optimizing amoxicillin dosing and adherence to weight-based regimens are key modifiable factors to improve eradication. Objective This multicenter study aimed to evaluate real-world Hp eradication rates in Colombian children and identify independent predictors of treatment success. Methods Secondary analysis of the multicenter "LatamPed-Hp" REDCap registry in REDCap included 26 centers in 14 Colombian cities, including treatment-naïve children with confirmed Hp infection. Demographic data, clinical symptoms, and pharmacological regimens were recorded. Eradication was confirmed after four weeks post-treatment primarily via non-invasive methods. Factors associated with success were analyzed using bivariate tests and a multivariable logistic regression model. Results A total of 330 patients were included (mean age 11.0 ± 3.8 years; 52.7% female). The overall eradication rate was 81.8% (270/330). Bivariate analysis showed that success was significantly associated with treatment adherence (p < 0.001), absence of non-gastrointestinal comorbidities (p = 0.005), and adequate amoxicillin dosing (p = 0.017). In the multivariable model, adequate weight-based amoxicillin dosing was a robust independent predictor of success (adjusted odds ratio (aOR) 2.76; 95% confidence interval (CI): 1.11-6.86; p = 0.028). Adherence remained the strongest protective factor (aOR 48.99; p < 0.001), while non-gastrointestinal comorbidities increased the odds of failure (aOR 0.21; p < 0.001). The model demonstrated high accuracy (84.59%) and sensitivity (98.31%). Conclusion Eradication rates in Colombian children remain below international targets. Pharmacological precision, specifically adequate amoxicillin dosing, is a critical modifiable factor for success. Ensuring strict adherence to weight-based protocols and improving treatment compliance are essential strategies to optimize Hp eradication and reduce long-term gastric cancer risk in this population.