High Helicobacter pylori eradication rate with a 1‐week regimen containing ranitidine bismuth citrate

Abstract

Background: High Helicobacter pylori eradication rates have consistently been reported with 2‐week dual therapy regimens of ranitidine bismuth citrate plus clarithromycin. Ranitidine bismuth citrate with two antibiotics may provide an alternative 1‐week eradication regimen. Methods: This double‐blind, randomized, parallel group, international, multicentre study compared ranitidine bismuth citrate 400 mg b.d. and clarithromycin 500 mg b.d. for 2 weeks (RC) with ranitidine bismuth citrate 400 mg b.d., clarithromycin 500 mg b.d. and metronidazole 400 mg b.d. for 1 week (RCM) for eradication of H. pylori in 350 patients with dyspepsia. Results: Treatment with RC and RCM eradicated H. pylori (established by the combination of two negative results from two discrete 13C‐UBTs at nominal weeks 4 and 12) from 89% (95% CI: 84–94) and 92% (95% CI: 88–97) of the observed population, and from 78% (95% CI: 72–84) and 80% (95% CI: 75–86) of the intention‐to‐treat population. When established only by one negative 13C‐UBT result at least 28 days after the end of treatment, the respective intention‐to‐treat rates were 85% (95% CI; 79–90) and 88% (95% CI: 83–93). Both regimens were well‐tolerated, only 6% of patients given RC and 4% given RCM discontinued treatment. Median plasma bismuth concentrations at the end of the second week of study were low, at 3.5 and 0.4 ng/mL, respectively. Conclusions: Ranitidine bismuth citrate triple therapy for 1 week (RCM) and dual therapy for 2 weeks (RC) were equally effective for the eradication of H. pylori infection.

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

“…Our study shows that a triple regimen containing RBC plus low‐dose clarithromycin and metronidazole produces excellent eradication rates when it is given for at least 7 days. This finding confirms the good performance of previous studies with this 1‐week regimen 6 –8 and the achievement of more than 80% eradication rates on intention‐to‐treat analysis is in full accordance with the criteria of the Maastricht Consensus meeting 1 . Prolonging the treatment to 10 days does not confer any advantage in terms of eradication rates and, moreover, augments costs and side‐effects.…”

“…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 …”

One‐week use of ranitidine bismuth citrate, amoxycillin and clarithromycin for the treatment of Helicobacter pylori‐related duodenal ulcer

“…Recently, in a European multicentre prospective randomized trial, RBC (400 mg) was co‐prescribed with clarithromycin 500 mg and metronidazole 400 mg b.d. for 1 week and compared with the standard RBC–clarithromycin dual therapy for 2 weeks in a group of dyspeptic patients 9 . The results of this study suggested that a 1‐week regimen of RBC‐based triple therapy is sufficient to cure the infection.…”

The European meeting on Helicobacter pylori: therapeutic news from Lisbon

“…The results of seven day treatment arms grouped for the main combinations of antimicrobial agents are given in figures 1-3. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Is more better?…”