Ranitidine Bismuth Citrate Can Help to Overcome <i>Helicobacter pylori</i> Resistance to Clarithromycin In Vivo

Mégraud, Françis; Roberts, Peter M.; Williamson, Russell

doi:10.1046/j.1523-5378.2000.00034.x

Cited by 23 publications

(18 citation statements)

References 20 publications

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“…In Turkey, we suggest that there is a high resistance rate of H. pylori to second-generation fluoroquinolones due to the frequent consumption of first-generation fluoroquinolones in the outpatient community and the reported cross-resistance between the firstand second-generation fluoroquinolones [25]. Furthermore, our results are consistent with a newly published study from Turkey reporting an eradication rate of 42.2% for the intention-to treat analysis and 47.6% for the per-protocol analysis with a 14-day treatment regimen of pantoprazole plus moxifloxacine and amoxicillin [29]. RBC-based triple therapies were found to have better eradication rates than standard and moxifloxacine-based triple therapies.…”

Section: Discussionsupporting

confidence: 90%

Moxifloxacine Plus Amoxicillin and Ranitidine Bismuth Citrate or Esomeprazole Triple Therapies for Helicobacter pylori Infection

et al. 2008

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Up to 20% of patients, or even more, will fail to obtain eradication after a standard triple therapy. The aim of this study is to evaluate the efficacy of moxifloxacine-containing regimens in the first-line treatment of Helicobacter pylori. One hundred and twenty H. pylori-positive patients were randomized into four groups to receive one of the following 14-day treatments: ranitidine bismuth citrate (RBC) 400 mg b.d. plus amoxicillin 1 g b.d. and clarithromycin 500 mg b.d. (RAC group, n = 30); RBC 400 mg b.d. plus moxifloxacine 400 mg o.d. and amoxicillin 1,000 mg b.d. (RAM group, n = 30); esomeprazole 40 mg b.d. plus amoxicillin 1,000 mg b.d. plus clarithromycin 500 mg b.d. (EAC group, n = 30); and esomeprazole 40 mg b.d. plus amoxicillin 1,000 mg b.d. plus moxifloxacine 400 mg o.d. (EAM group, n = 30). Eradication was assessed by (13)C urea breath test 8 weeks after therapy. Per-protocol and intention-to-treat eradication was achieved in 23 out of 30 patients (76.7%, 95% confidence interval [CI]: 61-92) in the RAC group, in 20 patients (66.7%, 95% CI: 49-84) in the RAM group, in 16 patients in the EAM group (53.3%, 95% CI: 34-71), and in 19 patients in the EAC group (63.3%, 95% CI: 54-72). Mild or moderate side-effects were significantly more common in the EAM group (70%) compared to the RAC (36.6%), RAM (43.3%), and EAC (56.6%) groups (P = 0.03). From our results, we conclude that moxifloxacine-containing triple therapies have neither eradication nor compliance advantages over standard triple therapies. Further studies with new antibiotic associations are needed for the better eradication of H. pylori in developing regions of the world.

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Section: Discussionsupporting

confidence: 90%

Moxifloxacine Plus Amoxicillin and Ranitidine Bismuth Citrate or Esomeprazole Triple Therapies for Helicobacter pylori Infection

et al. 2008

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“…A significant difference was found, the combination which included ranitidine bismuth citrate (86% eradication versus 59% in the omeprazole group, p < 0.05) was found to be more effective. This result agrees with previous evidence [46].…”

Section: Re-treatment After Hp Eradication Failuresupporting

confidence: 94%

“…It seems to be a useful addition as it can help to overcome the Hp resistance to clarithromycin in vivo [46], although more studies are needed to confirm this observation.…”

Section: Ranitidine Bismuth Citratementioning

confidence: 95%

“…Perhaps ranitidine bismuth subcitrate could substitute for omeprazole in these regimens and in fact some limited data suggest some resistance could be overcome using this drug [46] and there is one randomised trial which suggests this is a real alternative [80]. Rifabutin seems to be a very interesting drug which could be tested in these patients according to recent data [85] and not yet reported in patients with failure of previous treatment.…”

Section: Re-treatment After Hp Eradication Failurementioning

confidence: 99%

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Helicobacter pylori: strategies for treatment

Gomollón¹,

Sicilia²

2001

Expert Opinion on Investigational Drugs

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Helicobacter pylori (Hp) is a Gram-negative bacteria able to live in the human stomach, a very surprising fact considering the acid environment of gastric mucosa. Identified by Marshall and Warren in 1982 [1,2], this bacterium seems aetiologically related to many gastric diseases, previously known as 'acid related diseases'. Compelling evidence demonstrates that Hp is the most important aetiological agent of gastritis [3], the principal causal factor in peptic ulcer [4], contributes to the genesis of gastric cancer [5] and has a critical role in the development of many mucosa-associated lymphoid tissue (MALT) lymphomas [6]. Although experimental data have recently provided hard evidence to support the role of Hp in the genesis of gastritis, ulcer and carcinoma [7], a critical argument for Hp generating peptic ulcer disease has been, in fact, the change in the natural history of peptic ulcer that follows the cure of the infection.

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“…Mégraud et al [36] cultured H. pylori and determined the clarithromycin susceptibility before and after treatment with RBC or omeprazole plus clarithromycin. The overall eradication rate was 89% in the RBC group and 53% in the omeprazole group, suggesting a synergy between RBC and clarithromycin in vivo.…”

Section: Esomeprazolementioning

confidence: 99%

<i>Helicobacter pylori</i> Therapy: First-Line Options and Rescue Regimen

Gisbert

Jm²

2001

Dig Dis

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In the present paper, several points regarding Helicobacter pylori treatment are reviewed, with the following conclusions: (1) all different proton pump inhibitors (PPIs) are equivalent when prescribed with antibiotics; (2) ranitidine bismuth citrate is equal to or, in some cases with antibiotic resistance, more effective than PPI; (3) previous treatment with PPI does not seem to affect the rate of eradication obtained with PPI plus two antibiotics; (4) just 1 week of PPI is enough to obtain duodenal ulcer healing, provided that H. pylori eradication is achieved; (5) the eradication rates seem to be higher in peptic ulcer than in nonulcer dyspepsia; (6) in areas where the prevalence of metronidazole resistance is high, triple therapy including a PPI, clarithromycin, and amoxicillin is the best option, and (7) quadruple therapy (PPI, bismuth, tetracycline, and metronidazole) is the recommended second-line therapy after PPI-clarithromycin-amoxicillin failure, although replacing the PPI and the bismuth compound by ranitidine bismuth citrate achieves also good results.

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Ranitidine Bismuth Citrate Can Help to Overcome Helicobacter pylori Resistance to Clarithromycin In Vivo

Abstract: A synergy between RBC and clarithromycin may exist in vivo and, while clarithromycin resistance is increasing, it is an argument for using RBC in triple therapies.

Cited by 23 publications

References 20 publications

Moxifloxacine Plus Amoxicillin and Ranitidine Bismuth Citrate or Esomeprazole Triple Therapies for Helicobacter pylori Infection

Moxifloxacine Plus Amoxicillin and Ranitidine Bismuth Citrate or Esomeprazole Triple Therapies for Helicobacter pylori Infection

Helicobacter pylori: strategies for treatment

<i>Helicobacter pylori</i> Therapy: First-Line Options and Rescue Regimen

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