One‐week therapy for <i>Helicobacter pylori</i> eradication: ranitidine bismuth citrate plus medium‐dose clarithromycin and either tinidazole or amoxycillin

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.

Section: Resultsmentioning

confidence: 99%

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

Pipkin

Williamson

Wood

1998

“…More recently triple therapies with RBC were investigated. These trials showed eradication rates comparable to proton pump inhibitor triple therapy and the European Helicobacter Study Group has acknowledged that these regimens met the criteria agreed upon at the Maastricht consensus meeting 5 –9 . In a recent review of the current literature published by our group, both RBC‐ and proton pump inhibitor‐based therapies showed comparable effectiveness 10 .…”

Section: Introductionmentioning

confidence: 99%

Review article: treatment of Helicobacter pylori infection with ranitidine bismuth citrate‐ or proton pump inhibitor‐based triple therapies

Oijen

Verbeek

Jansen

et al. 2000

Triple therapy, combining a proton pump inhibitor with clarithromycin (C) and either amoxycillin (A) or a nitro‐imidazole (I) is the standard in Helicobacter pylori eradication therapy. Recently, triple therapies based on ranitidine bismuth citrate (RBC) have emerged as an alternative. This review examines the current literature for studies directly comparing proton pump inhibitor‐ with RBC‐based triple therapies. Seventeen studies were identified, of which three have been published as a full paper. Eradication rates in an intention‐to‐treat analysis ranged from 51 to 98%. No large difference in cure rates between the different regimens was demonstrated, although the RBC‐I‐C combination was somewhat superior. No definite conclusions could be made about the impact of metronidazole or clarithromycin resistance since only three studies performed a formal resistance analysis. No serious side‐effects were reported, and dropout rates were equal for the two regimens. Both RBC‐ and proton pump inhibitor‐based triple therapies are highly effective. If one prefers a imidazole/clarithromycin combination the evidence presented here suggests that RBC should be used instead of a proton pump inhibitor. Larger studies comparing both forms of triple therapy, using proper resistance analysis, are needed before final conclusions can be reached regarding efficacy in the setting of bacterial resistance.

“…The suggested first line therapies for H. pylori eradication are based on an antisecretory agent (a proton pump inhibitor or ranitidine bismuth citrate) and two antibiotics in association for 7 days, while as far as second line therapies are concerned, i.e. in the case of treatment failure, a variety of agents have been employed, but large scale trials have not been conducted to establish the optimal regimen 3 –7 . Major causes of failure may be poor patient compliance (many tablets have to be taken per day and/or side‐effects may occur), inappropriate treatment prescription, and finally, the presence of a primary, or the development of a secondary, resistance to strains 8 .…”

Section: Introductionmentioning

confidence: 99%

Efficacy of a multistep strategy for Helicobacter pylori eradication

Gasbarrini

Ojetti

Armuzzi

et al. 2000

Since the human pathogen Helicobacter pylori was recognized as the most important aetiologic agent of chronic gastritis and as a major factor for peptic ulcer pathogenesis, the therapeutic approach to these common diseases has completely changed. 1 It has been well documented that H. pylori eradication not only heals duodenal ulcers, but also results in a marked decrease of peptic ulcer recurrence. 2 Despite the importance of H. pylori eradication in the management of a variety of upper gastrointestinal tract diseases and the many advances in eradication therapy over the last few years, treatment failure remains a signi®cant problem, eradication rates still being roughly 70±80%. The suggested ®rst line therapies for H. pylori eradication are based on an antisecretory agent (a proton pump inhibitor or ranitidine bismuth citrate) and two antibiotics in association for 7 days, while as far as second line therapies are concerned, i.e. in the case of treatment failure, a variety of agents have been employed, but large scale trials have not been conducted to establish the optimal regimen. 3±7 Major causes of failure may be poor patient compliance (many tablets have to be taken per day and/or side-effects may occur), inappropriate treatment prescription, and ®nally, the presence of a primary, or the development of a secondary, resistance to strains. 8 Because the development of antibiotic resistant strains is one of the major SUMMARY Background: Helicobacter pylori eradication therapies do not achieve 100% success rates. Antibiotic resistant strains are among the major causes of failure. Current recommendations concerning the management of treatment failures are not fully clear. Aim: To evaluate the ef®cacy of a multi-step therapeutic strategy in a large group of infected patients. Methods: A total of 2606 H. pylori-positive patients were administered tinidazole, clarithromycin and a proton pump inhibitor for 1 week. Patients with continuing infection were then given a second 1-week course of amoxycillin, clarithromycin and ranitidine bismuth citrate. Patients still infected after the second course underwent upper gastrointestinal endoscopy with H. pylori culture, and then received a 1-week