The prevalence of metronidazole-resistant H. pylori strains remained static whilst the prevalence of clarithromycin-resistant strains was not rare in Hong Kong. An alarming 7.2% of patients were resistant to both the antimicrobials, which had a definite impact on treatment success. All cases of resistance to clarithromycin were due to A2144G mutation in 23S rRNA of H. pylori.

Aim: To compare 1‐week ranitidine bismuth citrate‐based (RBC) triple therapy vs. omeprazole‐based (O) triple therapy for the eradication of Helicobacter pylori infection in Hong Kong with high prevalence of metronidazole resistance. Methods: Patients with non‐ulcer dyspepsia and H. pylori infection were randomized to receive either: (i) RBCCM: ranitidine bismuth citrate (pylorid) 400 mg, clarithromycin 250 mg and metronidazole 400 mg; or (ii) OCM: omeprazole 20 mg, clarithromycin 250 mg and metronidazole 400 mg, each given twice daily for 1 week. Endoscopy (CLO test, histology and culture) and 13C‐urea breath test were performed before randomization and 6 weeks after drug treatment. Results: A total of 180 patients were randomized. H. pylori eradication rates (intention‐to‐treat, n=180/per protocol, n=166) were 83%/92% for RBCCM and 66%/70% for OCM (P=0.01, intention‐to‐treat and P=0.001, per protocol, respectively). RBCCM treatment was unaffected by metronidazole susceptibility and achieved a significantly higher eradication rate in metronidazole‐resistant cases (89%) than the OCM group (45%, P=0.0064). Conclusion: One‐week ranitidine bismuth citrate‐based triple therapy is significantly better than omeprazole‐based triple therapy for the eradication of H. pylori infection, especially in metronidazole‐resistant cases. It is an effective regimen for the eradication of H. pylori infection in regions with a high prevalence of metronidazole resistance.

Aim: To test the efficacy of omeprazole, furazolidone and amoxicillin triple therapy for the treatment of Helicobacter pylori infection after failure of standard first‐line therapy recommended by the Asia‐Pacific Consensus on the management of H. pylori infection. Methods: Patients with failed H. pylori eradication received omeprazole, 20 mg, furazolidone, 100 mg, and amoxicillin, 1 g, all twice daily for 1 week. Endoscopy (CLO test, histology and culture) was performed before treatment. Post‐treatment H. pylori status was determined by 13C‐urea breath test 6 weeks later. Results: Fifty patients were recruited. Resistance to metronidazole, clarithromycin and both drugs was in the range of 50–64%, 60–75% and 40–50%, respectively, after failure of first‐line therapy. Amoxicillin resistance was not found. The intention‐to‐treat and per protocol H. pylori eradication rates were 52% and 53%, respectively. Patients with double resistance to metronidazole and clarithromycin showed the lowest eradication rate (38%), which was significantly lower than that of patients with sensitive strains (88%). Side‐effects were minimal and compliance was excellent (98%). Conclusions: One‐week omeprazole, furazolidone and amoxicillin rescue therapy achieved a high eradication rate in strains sensitive to metronidazole and clarithromycin. This is a cheap and safe rescue regimen when guided by pre‐treatment sensitivity testing.