Seven‐day treatment for Helicobacter pylori infection: ranitidine bismuth citrate plus clarithromycin and tetracycline hydrochloride

Abstract

Background: Dual therapy with ranitidine bismuth citrate plus clarithromycin twice daily for 14 days is an effective regimen for eradicating Helicobacter pylori infection. Aim: To determine whether this regimen can be improved by the addition of a second antibiotic, tetracycline hydrochloride, whilst reducing the duration of treatment to 7 days. Methods: Sixty‐one out‐patients were enrolled to this open treatment study. All had H. pylori infection, as determined by 13C‐urea breath test and, for those undergoing endoscopy, by rapid urease test. Patients were treated with ranitidine bismuth citrate 400 mg, clarithromycin 500 mg and tetracycline hydrochloride 500 mg all twice daily for 7 days. Eradication of H.␣pylori was assessed by two separate 13C‐urea breath tests, the first 28–68 days after the completion of treatment, the second 28–162 days later. H. pylori infection was considered cured if both tests were negative. Results: All 61 patients were included in the intention‐to‐treat efficacy analysis. Successful eradication of H.␣pylori was achieved in 55/61 patients (90 %; 95% CI: 82–98%). Fifty‐nine out of sixty‐one patients reported 100% compliance; one patient missed a single dose of medication and the other withdrew at 48 h due to nausea and vomiting. Minor adverse events were reported by 30/61 patients. Conclusion: One‐week triple therapy with ranitidine bismuth citrate, clarithromycin and tetracycline, all twice daily, is a safe and well‐tolerated regimen which eradicates H. pylori in 90% of infected patients.

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

“…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 7 days produces eradication rates as high as 86% on an intention‐to‐treat analysis 6 . This excellent performance has been confirmed by other studies adopting either the same antibiotic combination 7 , 8 or tetracycline plus clarithromycin 9 …”

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

“…More recently, the use of RBC was proposed in association with two antibiotics as short‐term triple therapy. In three European studies, 15 –17 RBC‐based triple therapies achieved cure rates of 85–90% by intention‐to‐treat analysis.…”

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

“…for 7 days achieved a pooled eradication rate of 90% by both PP and ITT analyses 21 . On the other hand, other studies have demonstrated that a 7‐day course of treatment with RBC in combination with two antibiotics maintained the high eradication rates achieved with 2‐week dual therapy 8 –10 . In particular, RBC plus low doses of clarithromycin achieved ITT eradication rates ranging from 78 to 88% when associated with nitroimidazoles and from 71 to 81% when combined with amoxycillin 8 , .…”

“…Thus, RBC in combination with clarithromycin 1–1.5 g/day for 2 weeks, followed by RBC alone for another 2 weeks, has been shown to be effective in healing duodenal ulcer and curing H. pylori infection 6 , . 7 In the effort to make the RBC‐based regimens competitive with the modern short‐term, low‐dose proton pump inhibitor‐based triple therapies, several studies 8 –10 have recently demonstrated that a 7‐day co‐administration of RBC plus low or high dose clarithromycin and tinidazole, amoxycillin or tetracycline is an effective and well‐tolerated regimen for the eradication of H. pylori , achieving satisfactory eradication rates (71–90% for intention‐to‐treat and 82–93% for per protocol analysis, respectively). To improve the already effective results mentioned above, we carried out the present study, which compares two treatment arms including RBC with medium‐dose clarithromycin and either tinidazole or amoxycillin, administered for 1 week.…”