Ranitidine bismuth citrate, tetracycline, clarithromycin twice‐a‐day triple therapy for clarithromycin susceptible <i>Helicobacter pylori</i> infection

Graham,; Hoffman,; Anderson, Leticia; Qureshi,; Osato,; El‐Zimaity,

doi:10.1046/j.1365-2036.1999.00465.x

Cited by 7 publications

(5 citation statements)

References 20 publications

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“…Combinations that contained clarithromycin had the highest eradication rates. Clarithromycin containing regimens that have twice a day dosing may have better compliance, are cheaper and yet have good cure rates [22]. Similar eradication rates were seen when pantoprazole was used instead of omeprazole [23] and overall, there seems to be no PPI with an advantage over another such that the PPIs can be used interchangeably.…”

Section: Commonly Used Triple Therapies and The Effect Of Acid Suppresupporting

confidence: 66%

Antibiotic-Resistant H. pylori Infection and its Treatment

Graham

Qureshi²

2000

CPD

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Helicobacter pylori infection causes progressive damage to gastric mucosa and results in serious disease such as peptic ulcer disease, MALT lymphoma, or gastric adenocarcinoma in 20% to 30% of patients. The current approach is to make a firm diagnosis, give combination antibiotic and antisecretory therapy, and confirm that the infection has been cured 4 to 6 weeks later. Antimicrobial resistance is largely responsible for treatment failures. Resistance to metronidazole can frequently be overcome by increasing the dose and duration of treatment with acid suppression. Clarithromycin is the most effective antibiotic against H. pylori but, unfortunately, resistance to it is increasing and can not be overcome by increasing the dose or duration of therapy with clarithromycin. The choice of therapy should be based on local susceptibility patterns. Re-treatment regimens for treatment failure should exclude antibiotics where acquired resistance is expected (i.e., clarithromycin and possibly metronidazole). Where available, treatment failure should prompt endoscopy and culture and susceptibility testing. Overall, higher doses and longer durations of treatment result in the best cure rates. When multiple treatment regimens fail, salvage therapy regimens such as bismuth or furazolidone quadruple therapy (a bismuth and tetracycline HCl 4 times a day along with a proton pump inhibitor twice a day, and either metronidazole 400 or 500 mg three times daily or furazolidone 100 mg three times daily for 14 days) can be used. Newer agents are needed to cope with the increasing prevalence of antibiotic resistance among H. pylori.

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Section: Commonly Used Triple Therapies and The Effect Of Acid Suppresupporting

confidence: 66%

Antibiotic-Resistant H. pylori Infection and its Treatment

Graham

Qureshi²

2000

CPD

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“…Studies reporting duplicate data were excluded. After careful evaluation of the full texts, 48 studies reported detailed regimen and their eradication rates according to antibiotic resistances were finally included 4,5,12–57 …”

Section: Resultsmentioning

confidence: 99%

Susceptibility testing alone will not reliably achieve high Helicobacter pylori cure rates: A systematic review and meta‐analysis

Huang

Chen

Ding

et al. 2022

J of Gastro and Hepatol

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Background and Aim Not all the susceptibility‐guided therapies for Helicobacter pylori (H. pylori) infection achieve excellent eradication rates. The aim of this study was to perform a systematic review and meta‐analysis to identify the optimal regimen for H. pylori treatment based on antibiotic susceptibility. Methods A systematic search was performed in multiple databases. Studies reporting eradication rates of H. pylori with susceptibility‐guided therapies were selected. Meta‐analysis was conducted to calculate the pooled eradication rate among the treatment regimens. Results Forty‐eight eligible studies with 101 susceptibility‐guided treatment arms were included. The overall eradication rate in patients harboring susceptible strains was 95.0% (95% CI, 94.1–95.9%), but only 63.4% of treatment arms (64/101) achieved good eradication rates (≥ 90%). Pooled eradication rates in patients with susceptible strains were: 93.4% (95% CI, 92.0–94.8%) for clarithromycin, 99.0% (95% CI, 98.1–100%) for nitroimidazoles and 95.4% (95% CI, 93.6–97.2%) for fluoroquinolones. Among the arms using a triple therapy, 66.7% (28/42) using clarithromycin, 84.2% (16/19) using nitroimidazoles and 70.8% (17/24) using fluoroquinolones achieved good (≥ 90%) eradication rates. Of 13 arms using sequential therapy, ≥ 90% eradication was achieved in 14.3% (1/7) using clarithromycin, 25.0% (1/4) using nitroimidazoles and both arms (2/2) using fluoroquinolones. Conclusions Susceptibility testing alone seemed insufficient to reliably attain high H. pylori cure rates. The eradication rate in patients with nitroimidazoles susceptible strains was higher than those of fluoroquinolones and clarithromycin.

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“…Reasons for the conflicting results between the different studies are unknown. Treatment with RBC, tetracycline and clarithromycin for one to two weeks has been reported by two authors, with ITT eradication rates of over 90% in more than 100 patients (52,53).…”

Section: Rbc Triple Therapy In Ppi Triple Therapy Failuresmentioning

confidence: 92%

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, tetracycline, clarithromycin twice‐a‐day triple therapy for clarithromycin susceptible Helicobacter pylori infection

Abstract: Twice-a-day ranitidine bismuth citrate, tetracycline, clarithromycin triple therapy was well tolerated and effective for the treatment of H. pylori infection in patients with clarithromycin-susceptible H. pylori.

Cited by 7 publications

References 20 publications

Antibiotic-Resistant H. pylori Infection and its Treatment

Antibiotic-Resistant H. pylori Infection and its Treatment

Susceptibility testing alone will not reliably achieve high Helicobacter pylori cure rates: A systematic review and meta‐analysis

Ranitidine bismuth citrate: A review

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