Reply — Efficacy of 1‐week ranitidine‐ bismuth‐citrate (RBC)‐based triple therapy for eradication of Helicobacter pylori infection

Abstract

Ef®cacy of 1-week ranitidine-bismuth-citrate (RBC)-based triple therapy for eradication of Helicobacter pylori infection SIRS, We read the recent article by Hoffman et al. on the evaluation of a RBC-based triple regimen administered for only 1-week to eradicate Helicobacter pylori infection.1 They obtained excellent eradication rates (86% with ITT and 91% with PP) on a small number of patients (n 50) and therefore emphasize the effectiveness of this short-term triple therapy. The authors present their study as an original one, because they hypothesized that adding an inexpensive antibiotic (metronidazole) to the FDA-approved double regimen based on RBC 400 mg b.d. and clarithromycin 500 mg b.d., and giving these drugs only twice daily and for half the time commonly used in USA (7 instead of 14 days), would have improved its ef®cacy. Unfortunately, they seem not to be aware of the fact that this regimen has been already assessed and found to be excellent in a great number of previous studies. The ®rst experience with RBC combined with clarithromycin and metronidazole for 1 week was published 2 years ago by our group in a small, but randomized and controlled study. con®rmed our excellent results on larger series and nowadays the good performance of this new 1-week RBC-based regimen can be considered consolidated, as con®rmed by a recent paper showing the results of many studies using this therapeutic scheme.5 By pooling together all these trials, Pipkin et al. show that RBC-based triple therapy allows us to achieve high and consistent eradication rates, which are similar to those of proton pump inhibitor-based triple regimens. We are greatly surprised that Hoffman and co-workers did not mention at all in their article the above clinical trials. We think that the quality and relevance of their study are greatly reduced by several important methodological¯aws (lack of randomization and control) and by the apparent ignorance of the already published literature in this ®eld. V. SAVARINO & S. VIGNERI*