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7‐day rescue therapy with ranitidine bismuth citrate after Helicobacter pylori treatment failure
Author(s) -
Gisbert J. P.,
Fuentes J.,
Carpio D.,
Tito L.,
Guardiola J.,
Tomas A.,
Olivares D.,
Calvet X.
Publication year - 2005
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 - 10.1111/j.1365-2036.2005.02465.x
Subject(s) - metronidazole , medicine , ranitidine hydrochloride , regimen , ranitidine , helicobacter pylori , gastroenterology , amoxicillin , clarithromycin , urea breath test , adverse effect , pharmacology , antibiotics , microbiology and biotechnology , helicobacter pylori infection , biology
Summary Background : Quadruple rescue therapy requires a complex scheme with four drugs. Aim : To evaluate the efficacy of ranitidine bismuth citrate‐tetracycline‐metronidazole rescue regimen, and to compare two different metronidazole dose schemes. Methods : Prospective multicentre study including proton‐pump inhibitor + clarithromycin + amoxicillin failures. Rescue regimen included two 7‐day treatment: (i) ranitidine bismuth citrate (400 mg b.d.)‐tetracycline (500 mg q.d.s.)‐metronidazole (500 mg t.d.s.; RTM1); or (ii) the same regimen but with metronidazole 250 mg q.d.s. (RTM2). Eradication was confirmed with 13 C‐urea breath test. Results : A total of 150 patients were included (58 RTM1, 92 RTM2). All patients but two (one in each group) returned after treatment. About 86% in group RTM1 and 95% in RTM2 correctly took all the medications ( P = 0.076). Per‐protocol eradication rates with RTM1 and RTM2 were 74 (95% CI: 60–84) and 69% (59–78). The intention‐to‐treat eradication rates were 64 (51–75) and 70% (59–78; P > 0.05). The type of regimen was not associated with eradication in the multivariate analysis. Adverse effects were more frequent with RTM1 (41%) than with RTM2 (30%; P > 0.05). Conclusion : Seven‐day triple rescue therapy with ranitidine bismuth citrate‐tetracycline‐metronidazole is effective for Helicobacter pylori eradication, and represents an encouraging alternative to quadruple therapy, with the advantage of simplicity. The administration of metronidazole every 6 h (together with tetracycline), and at a low dose (250 mg), achieves similar efficacy and is probably associated with a better compliance and a lower incidence of adverse effects.