Tips for optimizing esomeprazole therapy in children and adolescents.
Give esomeprazole 30–60 minutes before breakfast (and before dinner if dosing twice daily) to ensure maximal acid suppression.
Review antiretrovirals and CYP2C19 substrates before starting; esomeprazole can markedly reduce atazanavir levels and blunt clopidogrel activation.
Plan a follow-up within 6–8 weeks to consider tapering or discontinuation and to monitor for recurrence of symptoms.
For triple therapy, use pill boxes or calendars and counsel families that strict 14-day adherence improves eradication rates.