One-week ranitidine bismuth citrate-based triple therapy for the eradication of Helicobacter pylori in Hong Kong with high prevalence of metronidazole resistance

Aliment Pharmacol Ther. 2001 Mar;15(3):403-9. doi: 10.1046/j.1365-2036.2001.00932.x.

Abstract

Aim: To compare 1-week ranitidine bismuth citrate-based (RBC) triple therapy vs. omeprazole-based (O) triple therapy for the eradication of Helicobacter pylori infection in Hong Kong with high prevalence of metronidazole resistance.

Methods: Patients with non-ulcer dyspepsia and H. pylori infection were randomized to receive either: (i) RBCCM: ranitidine bismuth citrate (pylorid) 400 mg, clarithromycin 250 mg and metronidazole 400 mg; or (ii) OCM: omeprazole 20 mg, clarithromycin 250 mg and metronidazole 400 mg, each given twice daily for 1 week. Endoscopy (CLO test, histology and culture) and 13C-urea breath test were performed before randomization and 6 weeks after drug treatment.

Results: A total of 180 patients were randomized. H. pylori eradication rates (intention-to-treat, n=180/per protocol, n=166) were 83%/92% for RBCCM and 66%/70% for OCM (P=0.01, intention-to-treat and P=0.001, per protocol, respectively). RBCCM treatment was unaffected by metronidazole susceptibility and achieved a significantly higher eradication rate in metronidazole-resistant cases (89%) than the OCM group (45%, P=0.0064).

Conclusion: One-week ranitidine bismuth citrate-based triple therapy is significantly better than omeprazole-based triple therapy for the eradication of H. pylori infection, especially in metronidazole-resistant cases. It is an effective regimen for the eradication of H. pylori infection in regions with a high prevalence of metronidazole resistance.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use*
  • Anti-Infective Agents / pharmacology
  • Anti-Infective Agents / therapeutic use*
  • Anti-Ulcer Agents / pharmacology
  • Anti-Ulcer Agents / therapeutic use*
  • Bismuth
  • Breath Tests
  • Carbon Isotopes
  • Clarithromycin / pharmacology
  • Clarithromycin / therapeutic use*
  • Drug Resistance
  • Drug Therapy, Combination
  • Female
  • Helicobacter Infections / drug therapy*
  • Helicobacter Infections / pathology
  • Hong Kong / epidemiology
  • Humans
  • Male
  • Metronidazole / pharmacology
  • Metronidazole / therapeutic use*
  • Middle Aged
  • Omeprazole / pharmacology
  • Omeprazole / therapeutic use*
  • Prevalence
  • Ranitidine / analogs & derivatives
  • Treatment Outcome
  • Urea / analysis

Substances

  • Anti-Bacterial Agents
  • Anti-Infective Agents
  • Anti-Ulcer Agents
  • Carbon Isotopes
  • Metronidazole
  • ranitidine bismuth citrate
  • Ranitidine
  • Urea
  • Clarithromycin
  • Omeprazole
  • Bismuth