Efficacy and safety of three 7‐day Helicobacter pylori eradication regimens containing ranitidine bismuth citrate

SUMMARYBackground: The resistance of Helicobacter pylori to antibiotics has been advocated as a major cause of treatment failure, and antimicrobial sensitivity testing has been proposed to improve efficacy; however, its role before firstline therapy has not been investigated in detail. Aim: To assess whether antimicrobial sensitivity testing improves the eradication rate of first-line anti-Helicobacter treatments and to compare the effectiveness of ranitidine bismuth citrate and omeprazole in the presence of H. pylori resistance to antibiotics. Methods: Two hundred and forty-two patients were assigned to either empirical or antimicrobial sensitivity testing-based treatment; within each group, subjects were further randomized to receive ranitidine bismuth citrate, 400 mg b.d., tinidazole, 500 mg b.d., and

Section: Discussioncontrasting

confidence: 66%

Role of antibiotic sensitivity testing before first‐line Helicobacter pylori eradication treatments

Neri¹,

Milano²,

Laterza³

et al. 2003

“…Reports of 10 studies with ranitidine bismuth citrate, clarithromycin and amoxycillin (RCA) were found 13–22. ITT eradication rates were available from all but one,22 giving a pooled rate of 82.0% ( n = 427/521); range 39–94% 19.…”

Section: Resultsmentioning

confidence: 99%

One‐week clarithromycin triple therapy regimens for eradication of Helicobacter pylori

Pipkin

Williamson

Wood

1998

Background: One‐week triple therapies have been endorsed as the treatment regimens of choice for eradication of Helicobacter pylori infection. Those that include clarithromycin appear to be the most effective. Aim: To review reports of triple therapies that include clarithromycin. Methods: Reports were identified from the literature to May 1998. The variation between study designs prevents a formal meta‐analysis. A measure of the relative efficacies of regimens has, however, been gained by comparison and by pooling of intention‐to‐treat eradication rates. Results: One hundred and ninety‐two studies were identified which included 264 treatment arms of a 1‐week triple therapy composed of clarithromycin with amoxycillin or a nitroimidazole (metronidazole or tinidazole), and either ranitidine bismuth citrate or a proton pump inhibitor (omeprazole, lansoprazole or pantoprazole). From reports of these studies, an intention‐to‐treat H. pylori eradication rate could be determined from 210 treatment arms of 151 studies. Conclusions: There is little to choose between the efficacies of 1‐week clarithromycin‐based triple therapy eradication regimens. However, those comprising clarithromycin, a nitroimidazole and either ranitidine bismuth citrate or a high dose of omeprazole are, in general, the most effective. Against antibiotic‐resistant strains of H. pylori, regimens including ranitidine bismuth citrate may be more effective than those including a proton pump inhibitor.

“…Their rates ranged from 9% to 20% and are comparable to those reported in previous studies using RBC-based triple therapies. 6, 26 Withdrawal of treatment occurred in only four cases and this was due to the appearance of repeated vomiting, signi®cant diarrhoea (two patients) and epigastric pain. These adverse effects caused treatment to be discontinued in three patients from group C, thus con®rming that the longer the duration of therapy, the higher the frequency of relevant disturbances.…”

Section: Discussionmentioning

confidence: 99%

Optimal duration of therapy combining ranitidine bismuth citrate with clarithromycin and metronidazole in the eradication of Helicobacter pylori infection

Savarino

Zentilin

Bisso

et al. 1999

INTRODUCTIONAt present, 1-week proton pump inhibitor-based triple therapy is the most recommended regimen for the treatment of H. pylori infection.1 From the ®rst successful experience of Bazzoli and his group, 2 other clinical trials, both small and large 3,4 have con®rmed the ef®cacy of this short-term multiple treatment. In recent years, however, the novel compound ranitidine bismuth citrate (RBC) has been shown to be an effective antiHelicobacter drug when combined with clarithromycin for 14 days.5 In relation to the good results of 1-week proton pump inhibitor-based triple therapy, we have recently shown that shortening the treatment with RBC plus low-dose clarithromycin and metronidazole to SUMMARY Background: Ranitidine bismuth citrate (RBC) co-prescribed with clarithromycin and metronidazole for 1 week has been shown to be an effective eradicating regimen for Helicobacter pylori. Aim: To determine the optimal duration of this regimen. Methods: A series of 165 dyspeptic patients were recruited for this randomized, open, parallel-group study. They were subdivided into three groups receiving RBC 400 mg b.d. plus clarithromycin 250 mg b.d. and metronidazole 500 mg b.d. for three different periods (4, 7 and 10 days). H. pylori infection was assessed by the concomitant positivity of CLO-test and histology performed at the pre-entry endoscopy. The bacterium was considered eradicated on the basis of a negative 13 Curea breath test performed at least 28 days after the completion of treatment. Results: The three subgroups were well matched and 16 patients dropped out of the study for many reasons (six