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

Savarino, Vincenzo; Zentilin, Patrizia; Bisso, G.; Pivari, Monica; Bilardi, C.; Biagini, R.; Mele, Maria Raffaella; Mansi, C.; Termini, R; Vigneri, Sergio; Celle, G

doi:10.1046/j.1365-2036.1999.00436.x

Cited by 22 publications

(19 citation statements)

References 25 publications

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“…Several randomised controlled trials have compared short versus longer treatments [5, 29, 30, 31], but among these, only two studies comparing 2/4 days with 7/10 days have shown a significant difference [32, 33, 34]. However, up to 20% of peptic ulcer treated with the short-term protocol may still be active 1 month after the end of treatment increasing the risk of unhealed ulcers [34, 35].…”

Section: Discussionmentioning

confidence: 99%

Eradication Therapy with Rabeprazole versus Omeprazole in the Treatment of Active Duodenal Ulcer

Crea

Terminella²,

Branciforte³

et al. 2002

Digestion

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Background: Rabeprazole has been demonstrated to be a potent antisecretory agent and has been shown to be clinically effective in the treatment of acid-related diseases. Aims: It was to determine the efficacy of rabeprazole at 20 and 40 mg in addition to amoxicillin and clarithromycin in the treatment of active Helicobacter pylori-positive duodenal ulcers compared with omeprazole 40 mg. Patients and Methods: One hundred and twenty-seven patients were randomised into three treatment groups: 40 patients were treated with rabeprazole 40 mg daily, 42 patients with rabeprazole 20 mg daily and 45 patients with omeprazole 40 mg daily for 10 days. All patients received amoxicillin 1 g twice a day and clarithromycin 500 mg twice a day for 5 days. All patients were re-assessed at least 4 weeks after the end of the treatment. Results: According to the intention-to-treat (ITT) protocol, ulcer healing was observed in 90% of patients in the rabeprazole 40 group, in 85.7% in the rabeprazole 20 group and in 93.3% in the omeprazole 40 group. We observed H. pylori eradication in 90% ITT in the rabeprazole 40 group, in 80.9% ITT in the rabeprazole 20 group and in 88.8% ITT in the omeprazole 40 group. Statistical analysis did not show significant differences among the three groups. Conclusions: A 10-day rabeprazole 20 mg regimen represents an efficacious and safe regimen for H. pylori eradication and ulcer healing.

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Section: Discussionmentioning

confidence: 99%

Eradication Therapy with Rabeprazole versus Omeprazole in the Treatment of Active Duodenal Ulcer

Crea

Terminella²,

Branciforte³

et al. 2002

Digestion

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“…[12][13][14][15] Controversy still exists with regard to the duration of different treatment schemes for bacterial eradication, although studies have demonstrated an absence of significant difference for treatments that last 7, 10 or 14 days. 16,17 European and Asiatic multicenter studies have considered a 7-day scheme to be effective. 18,19 In Brazil, there is high prevalence of H. pylori, high incidence of strains resistant to nitromidazole and large segments of the population with low financial status.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic efficacy of ranitidine bismuth citrate with clarithromycin for seven days in the eradication of Helicobacter pylori in Brazilian peptic ulcer patients

et al. 2003

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CONTEXT: The curative treatment of peptic ulcer is made available nowadays through the eradication of the bacterium Helicobacter pylori, which is associated with it, but the best therapeutic regimen is yet to be determined. OBJECTIVE: To assess the efficacy of a therapeutic regimen with 400 mg ranitidine bismuth citrate associated with 500 mg clarithromycin given twice a day for seven days in a cohort of Brazilian patients with peptic ulcer. TYPE OF STUDY: Cross-sectional study. SETTING: Tertiary-care hospital. PATIENTS: One hundred and twenty nine outpatients, with active or healed peptic ulcers infected by Helicobacter pylori, diagnosed via endoscopy with confirmation via the urease test and histological examination, who had never undergone a regimen for the eradication of the bacterium. PROCEDURE: Administration of 400 mg ranitidine-bismuth and 500 mg clarithromycin twice a day, for seven days. MAIN MEASUREMENTS: Efficacy of the treatment, with a check on the cure done via another endoscopy eight weeks after drug administration. The eradication of the bacterium was determined via the urease test and histological examination. Patients who were negative for both were considered to be cured. RESULTS: Eight patients failed to complete the study. The eradication rate according to intention to treat was 81% (104/129) and per protocol was 86% (104/121). CONCLUSION: The bismuth ranitidine compound associated with clarithromycin used for one week was shown to be a simple, effective and well-tolerated therapeutic regimen for the eradication of Helicobacter pylori.

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“…Studies were excluded if one of the following settings was met: (1) pediatric studies; (2) duplicate, review, case, or incomplete data, sequential or intensified therapy; (3) studies with intravenous medication; (4) subjects who had active ulcer bleeding, regularly took any one of the PPI or H2-receptor antagonist (H2RA) during the 15-or 7-d period preceding the study, respectively, or antibiotics and bismuth up to four weeks before (Savarino et al, 1999); (5) similar drugs taken during the course of therapy or in the four-week period after stopping treatment, except antacids for symptom relief, or PPI for ulcer healing (Savarino et al, 1999); (6) previous H. pylori eradication; (7) total duration of antibiotic therapy in study group exceeding 6 d; (8) unusual use of PPI-containing triple protocols.…”

Section: Eligibility Criteriamentioning

confidence: 99%

Is short-term therapy really sufficient to eradicate Helicobacter pylori infection?

Zhou

Chen

Zhang

et al. 2010

J. Zhejiang Univ. Sci. B

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Abstract:Objective: The aim of our study was to perform a systematic review and meta-analysis of the efficacy of short-term protocols for Helicobacter pylori eradication and to review the safety and adverse profiles of these eradication protocols. Methods: Literatures were located through electronic searches by PubMed, Medline, ISI Web of Knowledge, and Cochrane Library using the relevant terms. Abstracts of important meetings were searched manually in some journal supplements. Additional bibliographies were identified from the reference lists of identified studies. Three independent reviewers systemically identified randomized controlled trials (RCTs) comparing short-duration protocols vs. 7-d proton pump inhibitor (PPI)-based triple protocols, as well as studies reporting eradication rates of short-duration protocols for H. pylori. Summary effect size was calculated as relative risk (RR) and 95% confidence intervals (CI) using Review Manager 4.2, and P<0.05 was defined as statistically significant in all analyses. Results: Among 90 abstracts retrieved, 15 studies were analyzed, including a total of 30 treatment regimens with 1856 subjects. Mean intention-to-treat (ITT) cure rates of 63.2% and 81.3% were achieved with short-term protocols and 7-d PPI-containing protocols, respectively. Per-protocol (PP)-based overall cure rates were 66.6% and 86.1%, respectively. Short-term therapy was inferior to 7-d triple regimen (P<0.00001). After sub-analysis, however, comparing the effects of ≥3-d protocols and 7-d triple protocols, the cumulative ITT RR was 0.95 (P=0.26), and PP RR was 0.95 (P=0.10), without significant heterogeneity. Moreover, slightly fewer adverse-effects were found in short-term protocols. Conclusions: Although more economical, short-duration protocols are inferior to 7-d PPI-based triple protocols with regarding to eradication rate of H. pylori. Protocols of more than 3 d, however, may be equivalent to 7-d protocols.

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

Cited by 22 publications

References 25 publications

Eradication Therapy with Rabeprazole versus Omeprazole in the Treatment of Active Duodenal Ulcer

Eradication Therapy with Rabeprazole versus Omeprazole in the Treatment of Active Duodenal Ulcer

Therapeutic efficacy of ranitidine bismuth citrate with clarithromycin for seven days in the eradication of Helicobacter pylori in Brazilian peptic ulcer patients

Is short-term therapy really sufficient to eradicate Helicobacter pylori infection?

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