Ranitidine bismuth citrate (RBC) based triple therapy for 7 days is more effective than RBC plus clarithromycin for 14 days in dyspeptic patients with <i>Helicobacter pylori</i> infection

Cestari,

doi:10.1046/j.1365-2036.1998.00394.x

Cited by 12 publications

(7 citation statements)

References 11 publications

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“…H. pylori eradication therapies based on RBC are markedly superior to those incorporating bismuth in the BC or BS formulations, and are about as effective as those incorporating proton pump inhibitors. Current 1 week RBC 44 –46 and proton pump inhibitor 47 triple therapies, for instance, typically achieved eradication rates better than 90%, compared with about 80% for classical 2 or 4 week BC and BS triple therapies 48 . The extent to which the inhibitory effect of RBC on the bacterial motor mechanism of H. pylori , revealed in our study contributes to the greater clinical effectiveness of RBC is difficult to quantify.…”

Section: Discussionmentioning

confidence: 71%

“…However, decreased H. pylori motility in the presence of RBC should in theory suppress colonization, 4 –6 and in vitro occurs at concentrations of the agent and with an immediacy suggesting that this pharmacological action will be of clinical importance. The idea that immobilization of the bacterium has a clinical role in current H. pylori eradication therapies 44 –47 is further supported by our finding (data unpublished) that proton pump inhibitors also inhibit H. pylori motility in vitro ; at concentrations well below those needed for anti‐bacterial action 49 …”

Section: Discussionmentioning

confidence: 75%

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Effects of ranitidine bismuth citrate on Helicobacter pylori motility, morphology and survival

Worku

Sidebotham

Karim

1999

Aliment Pharmacol Ther

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Aim : The effects of the anti‐ulcer agents ranitidine bismuth citrate (RBC), ranitidine hydrochloride (R) and colloidal bismuth citrate (BC), on Helicobacter pylori motility, morphology and survival were examined to determine whether the clinical effectiveness of RBC might be linked to a specific action that inhibits bacterial motility. Methods : H. pylori from patients with duodenal ulcer or non‐ulcer dyspepsia were exposed to RBC and BC at bismuth concentrations ranging from 12.5 to 50 μg/mL, and R at ranitidine concentrations ranging from 12.5 to 50 μg/mL for a brief period (< 15 min), 6 h and 24 h. Bacterial motility was assessed with a Hobson BacTracker, bacterial morphology by transmission electron microscopy, and growth inhibition by counting colony‐forming units. Results : H. pylori motility was diminished with RBC and BC but not R. However, the effect of RBC was markedly greater than that of BC at each bismuth concentration and time of exposure tested: (i) brief exposure to RBC/bismuth 50 μg/mL but not to BC, resulted in a significant loss of motility without loss of viability or change in cell morphology, and (ii) bacteria were immobilized, and lost viability after exposure to RBC/bismuth 50 μg/mL for 24 h but not to BC. Morphological destruction caused by RBC differed from that by BC: after 24 h exposure to the highest concentration tested, cell fragmentation and flagella detachment occurred more frequently with BC than RBC, but the latter produced greater disruption of intracellular structures. Conclusions : RBC suppresses growth of H. pylori, and has a specific inhibitory effect on the bacterial motor mechanism. These pharmacological actions are likely to contribute to the clinical effectiveness of the agent.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 75%

Effects of ranitidine bismuth citrate on Helicobacter pylori motility, morphology and survival

Worku

Sidebotham

Karim

1999

Aliment Pharmacol Ther

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“…When RBC is combined with two antimicrobials, the RBC-based triple therapy, it provides a higher ef®cacy of eradicating H. pylori and the therapy can be shortened to 7 days. 4,5 RBC-based triple therapy has also been shown to be comparable to proton pump inhibitor triple therapy in two studies using either omeprazole 6 or lansoprazole. 7 In vitro studies suggest that the use of RBC in combination with metronidazole SUMMARY Background: We have previously shown that ranitidine bismuth citrate (RBC)-based triple therapy is comparable to proton pump inhibitor-based triple therapy in eradicating Helicobacter pylori infection.…”

Section: Introductionmentioning

confidence: 99%

One‐week ranitidine bismuth citrate in combinations with metronidazole, amoxycillin and clarithromycin in the treatment of Helicobacter pylori infection: the RBC‐MACH study

Sung

Chan

et al. 1999

Aliment Pharmacol Ther

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Background : We have previously shown that ranitidine bismuth citrate (RBC)‐based triple therapy is comparable to proton pump inhibitor‐based triple therapy in eradicating Helicobacter pylori infection. Aim : To test the efficacy of different combinations of antimicrobials with RBC in the treatment of H. pylori infection. Methods : Dyspeptic patients with H. pylori infection were prospectively randomized to receive one of the following regimens: (i) RBC 400 mg, amoxycillin 1 g, clarithromycin 500 mg [RAC]; (ii) RBC 400 mg, metronidazole 400 mg, clarithromycin 500 mg [RMC]; (iii) RBC 400 mg, metronidazole 400 mg, tetracycline 1 g [RMT] (all given twice daily for 1 week); or (iv) RBC 400 mg plus clarithromycin 500 mg twice daily for 2 weeks [RC‐2]. Endoscopy (rapid urease test and culture) and 13C‐urea breath test (UBT) were performed before randomization. Four weeks after finishing medication, the 13C‐UBT was repeated in all cases and endoscopy was offered to patients with peptic ulcers. Results : Four hundred patients were randomized but in two (one in the RAC group and one in the RMC group) H. pylori infection was not confirmed. Successful eradication of H. pylori (intention‐to‐treat analysis and 95% CI) of RAC (86% [79–93%]), RMC (90% [84–96%]), RMT (79% [71–87%]) and RC‐2 (82% [75–90%]) were comparable, with a trend favouring clarithromycin‐containing triple therapy regimens. Among 276 isolates tested for antibiotic sensitivity, primary resistance to metronidazole, clarithromycin and amoxycillin was found in 56%, 2% and 0.4%, respectively. When given RMC or RMT, patients infected by metronidazole‐resistant H. pylori had success in eradicating H. pylori similar to patients infected by metronidazole‐sensitive H. pylori. Conclusion : One‐week RBC triple therapy is effective in curing H. pylori infection.

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“…Dual compared with triple therapy: RBC triple therapy for one week has been compared with dual therapy combining RBC and clarithromycin for two weeks (Tables 1, 3 and 4) (34-37). One study (34) found one-week triple therapy with RBC 400 mg bid, clarithromycin 250 mg bid and tinidazole 500 mg bid to be significantly better (P=0.001) than two-week dual therapy with RBC 400 mg bid and clarithromycin 500 mg bid (34). However, in other studies using RBC and clarithromycin dual therapy for two weeks, the proportion of patients cured was equivalent to those using RBC, clarithromycin and metronidazole triple therapy for one (36) or two weeks (26,37).…”

Section: Eradication Of H Pylori Infectionmentioning

confidence: 99%

Ranitidine bismuth citrate: A review

Chiba

Hunt

Thomson

2001

Canadian Journal of Gastroenterology

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Recognition of the relationship between Helicobacter pylori infection and the development of gastroduodenal disease has increased greatly in recent years. To avoid complications of H pylori infection, such as the development of recurrent duodenal and gastric ulcers, effective therapies are required for eradication of the infection. This article reviews ranitidine bismuth citrate (RBC), a novel complex of ranitidine, bismuth and citrate, which was developed specifically for the purpose of eradicating H pylori. Dual therapy with RBC in combination with clarithromycin for 14 days yields eradication rates of 76%. Triple therapy bid for one week with a proton pump inhibitor, clarithromycin and either amoxicillin or a nitroimidazole (tinidazole or metronidazole) is advocated as the treatment of choice for H pylori eradication. Analogous regimens with RBC in place of proton pump inhibitors show effective eradication rates in comparative studies and with pooled data. RBC, used alone or in combination with other antibiotics, appears to be a safe and effective drug for the treatment of H pylori infection. Bismuth levels do not appear to rise to toxic levels.

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Ranitidine bismuth citrate (RBC) based triple therapy for 7 days is more effective than RBC plus clarithromycin for 14 days in dyspeptic patients with Helicobacter pylori infection

Abstract: The 1-week treatment with RBC plus clarithromycin and tinidazole yielded higher eradication rates than the 2-week treatment with RBC plus clarithomycin. Both treatments were well tolerated.

Cited by 12 publications

References 11 publications

Effects of ranitidine bismuth citrate on Helicobacter pylori motility, morphology and survival

Effects of ranitidine bismuth citrate on Helicobacter pylori motility, morphology and survival

One‐week ranitidine bismuth citrate in combinations with metronidazole, amoxycillin and clarithromycin in the treatment of Helicobacter pylori infection: the RBC‐MACH study

Ranitidine bismuth citrate: A review

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