Ranitidine-bismuth citrate, tetracycline and metronidazole followed by triple therapy as alternative strategy for Helicobacter pylori treatment:: a pilot study

Background Eradication rates of triple therapy - a proton pump inhibitor, clarithromycin and amoxicillin twice daily for 7 days - are suboptimal in some areas of the world. Triple therapy combining ranitidine -bismuth citrate, tetracycline and metronidazole is a very effective secondline therapy. Management strategies including this treatment as first-line therapy may represent a reasonable choice. Aim To evaluate the efficacy of a strategy combining ranitidine-bismuth citrate triple therapy followed by a proton pump inhibitor-based triple therapy for Helicobacter pylori eradication in a pilot study. Patients and methods One hundred and thirty-six consecutive H. pylori-positive patients were treated with 400 mg ranitidine-bismuth citrate twice daily, 500 mg tetracycline three times daily and 500 mg metronidazole three times daily for 7 days. Second-line therapy consisted of 20 mg omeprazole twice daily, 500 mg clarithromycin twice daily and 1 g amoxicillin twice daily for 7 days. The efficacy of the treatment was evaluated by histology or the urea breath test. Results Cure rates were 109/136 patients [80.2%; 95% confidence interval (Cl), 72-86%] by intention to treat and 109/127 (85.8%; 95% Cl, 78-91%) per protocol. Fifteen of the patients with treatment failure received second-line treatment. Cure rates for the strategy as a whole were 119/136 (87.5%; 95% Cl, 81-92%) by intention to treat and 119/123 (96.8%; 95% Cl, 92-99%) per protocol. Conclusions The strategy achieves good eradication rates. As the first-line therapy avoids the use of clarithromycin, it could be useful in areas where high resistance to this antibiotic lead to poor results with triple therapy.