Dual and triple therapy regimens of antisecretory agents and antibiotics for the eradication of Helicobacter pylori: An overview

Background: Studies evaluating therapeutic regimens that combine antisecretory agents with antibiotics for the eradication of H. pylori have reported significant variations in efficacy. Methods: We reviewed the published literature to compare H. pylori eradication rates in patients treated with either omeprazole, ranitidine bismuth citrate (RBC), or ranitidine plus metronidazole combined with either amoxicillin or clarithromycin. Results: Wide variations in H. pylori eradication rates have been reported with omeprazole plus either amoxicillin (0-100%) or clarithromycin (42-88%). Eradication rates ranging from 45% to 89% and from 74% to 94% have been reported with RBC plus either amoxicillin or clarithromycin, respectively. Eradication rates ranging from 48% to 90% have been reported with ranitidine plus metronidazole and amoxicillin and one study reported an eradication rate of 95% with ranitidine plus metronidazole and clarithromycin. Conclusions: Well-controlled trials with ranitidine bismuth citrate plus clarithromycin suggest that this combination may provide the most consistent and effective regimen for the eradication of H. pylori infection.