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Head‐to‐head comparison of 1‐week triple regimens combining ranitidine or omeprazole with two antibiotics to eradicate Helicobacter pylori
Author(s) -
Vincenzo Savarino,
Patrizia Zentilin,
G. Bisso,
Monica Pivari,
Maria Raffaella Mele,
Mela Gs,
C. Mansi,
Sergio Vigneri,
R Termini,
G Celle
Publication year - 1999
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1046/j.1365-2036.1999.00522.x
Subject(s) - omeprazole , medicine , ranitidine , helicobacter pylori , antibiotics , gastroenterology , pharmacology , microbiology and biotechnology , biology
Background : Triple therapies containing omeprazole and ranitidine have been shown to be equivalent in eradicating H. pylori infection, but have been assessed either separately or head‐to‐head, only in small trials. Aim : To carry out a large randomized controlled study comparing omeprazole and ranitidine combined with two antibiotic combinations for 1 week. Methods : Three hundred and twenty H. pylori ‐positive patients were randomly subdivided into four equal‐sized groups and received one of the following treatments: OAM = omeprazole 20 mg b.d. + amoxycillin 1 g b.d. + metronidazole 500 mg b.d.; RAM = ranitidine 300 mg b.d. + amoxycillin 1 g b.d. + metronidazole 500 mg b.d.; OAC = omeprazole 20 mg b.d. + amoxycillin 1 g b.d. + clarithromycin 250 mg t.d.s.; RAC=ranitidine 300 mg b.d. + amoxycillin 1 g b.d. + clarithromycin 250 mg t.d.s. The assessment of H. pylori status was performed before and 4 weeks after the end of therapy by means of CLO‐test and histology. H. pylori infection was considered to be eradicated when both tests were negative. Results : OAM and RAM eradicated H. pylori in 89% and 85% of cases on per protocol ( P = 0.48) and in 77% and 75% of cases on intention‐to‐treat analyses ( P = 0.71). OAC and RAC eradicated H. pylori in 67% and 70% of cases on per protocol ( P = 0.68) and in 57% and 64% of cases on intention‐to‐treat analyses ( P = 0.41). In contrast, there was significant difference between OAM and OAC ( P < 0.01) and between RAM and RAC ( P < 0.05). Side‐effects occurred in 15%, 10%, 17% and 16% of patients with respect to the above four subgroups. Conclusions : Omeprazole and ranitidine combined with two antibiotics for 1 week are equally effective in the eradication of H. pylori infection, and these results question the role of profound acid suppression in the eradication of the bacterium.