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One-week ranitidine bismuth citrate versus colloidal bismuth subcitrate-based anti-Helicobacter triple therapy: a prospective randomized controlled trial.
Am J Gastroenterol 1999; 94(3):721-4AJ

Abstract

OBJECTIVE

The efficacy of 1 wk bismuth triple therapy is adversely influenced by the presence of metronidazole resistance. In vitro studies suggest that ranitidine bismuth citrate (RBC) plus metronidazole exhibit synergistic activity against metronidazole resistant strains of Helicobacter pylori (H. pylori). Whether this confers a superior clinical efficacy remains unproven. This study compared the efficacy of RBC-based triple therapy with bismuth triple therapy in eradication of H. pylori.

METHODS

Patients with H. pylori-related ulcer disease or gastritis were randomized to receive either 400/mg of RBC twice daily plus 400/mg of metronidazole and 500/mg of tetracycline four times daily for 1 wk (RMT) or 120/mg of colloidal bismuth subcitrate, 400/mg of metronidazole, and 500/mg of tetracycline, all given four times daily for 1 wk (BMT). Metronidazole susceptibility was determined by the E-test and pretreatment resistance was defined as minimum inhibitory concentration > or = 32/mg/L.

RESULTS

Of 100 consecutive patients randomized, two patients were lost to follow-up in each group. Forty-three of 85 (51%) H. pylori isolates were metronidazole resistant. Per-protocol cure rate for RMT and BMT was 40 of 41 (98%) and 37 of 44 (84%), respectively (p = 0.058). Intent-to-treat cure rate for RMT and BMT was 46 of 50 and 41 of 50, respectively (92% vs 82%, p = 0.23). A significantly higher eradication of metronidazole resistant H. pylori was observed in the RMT group (25 of 25, 100%) than in the BMT group (12 of 16, 75%), (p = 0.018). Side effects observed in the two treatment groups were comparable.

CONCLUSIONS

One week of RBC triple therapy with metronidazole and tetracycline is an effective anti-Helicobacter therapy. This regimen is more appropriate in areas of high prevalence of metronidazole resistance.

Authors+Show Affiliations

Department of Medicine, United Christian Hospital, Kowloon, Hong Kong.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10086657

Citation

Kung, N N., et al. "One-week Ranitidine Bismuth Citrate Versus Colloidal Bismuth Subcitrate-based anti-Helicobacter Triple Therapy: a Prospective Randomized Controlled Trial." The American Journal of Gastroenterology, vol. 94, no. 3, 1999, pp. 721-4.
Kung NN, Sung JJ, Yuen NW, et al. One-week ranitidine bismuth citrate versus colloidal bismuth subcitrate-based anti-Helicobacter triple therapy: a prospective randomized controlled trial. Am J Gastroenterol. 1999;94(3):721-4.
Kung, N. N., Sung, J. J., Yuen, N. W., Li, T. H., Ng, P. W., Lai, W. M., ... Leung, E. M. (1999). One-week ranitidine bismuth citrate versus colloidal bismuth subcitrate-based anti-Helicobacter triple therapy: a prospective randomized controlled trial. The American Journal of Gastroenterology, 94(3), pp. 721-4.
Kung NN, et al. One-week Ranitidine Bismuth Citrate Versus Colloidal Bismuth Subcitrate-based anti-Helicobacter Triple Therapy: a Prospective Randomized Controlled Trial. Am J Gastroenterol. 1999;94(3):721-4. PubMed PMID: 10086657.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - One-week ranitidine bismuth citrate versus colloidal bismuth subcitrate-based anti-Helicobacter triple therapy: a prospective randomized controlled trial. AU - Kung,N N, AU - Sung,J J, AU - Yuen,N W, AU - Li,T H, AU - Ng,P W, AU - Lai,W M, AU - Lui,Y H, AU - Lam,K N, AU - Choi,C H, AU - Leung,E M, PY - 1999/3/23/pubmed PY - 1999/3/23/medline PY - 1999/3/23/entrez SP - 721 EP - 4 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 94 IS - 3 N2 - OBJECTIVE: The efficacy of 1 wk bismuth triple therapy is adversely influenced by the presence of metronidazole resistance. In vitro studies suggest that ranitidine bismuth citrate (RBC) plus metronidazole exhibit synergistic activity against metronidazole resistant strains of Helicobacter pylori (H. pylori). Whether this confers a superior clinical efficacy remains unproven. This study compared the efficacy of RBC-based triple therapy with bismuth triple therapy in eradication of H. pylori. METHODS: Patients with H. pylori-related ulcer disease or gastritis were randomized to receive either 400/mg of RBC twice daily plus 400/mg of metronidazole and 500/mg of tetracycline four times daily for 1 wk (RMT) or 120/mg of colloidal bismuth subcitrate, 400/mg of metronidazole, and 500/mg of tetracycline, all given four times daily for 1 wk (BMT). Metronidazole susceptibility was determined by the E-test and pretreatment resistance was defined as minimum inhibitory concentration > or = 32/mg/L. RESULTS: Of 100 consecutive patients randomized, two patients were lost to follow-up in each group. Forty-three of 85 (51%) H. pylori isolates were metronidazole resistant. Per-protocol cure rate for RMT and BMT was 40 of 41 (98%) and 37 of 44 (84%), respectively (p = 0.058). Intent-to-treat cure rate for RMT and BMT was 46 of 50 and 41 of 50, respectively (92% vs 82%, p = 0.23). A significantly higher eradication of metronidazole resistant H. pylori was observed in the RMT group (25 of 25, 100%) than in the BMT group (12 of 16, 75%), (p = 0.018). Side effects observed in the two treatment groups were comparable. CONCLUSIONS: One week of RBC triple therapy with metronidazole and tetracycline is an effective anti-Helicobacter therapy. This regimen is more appropriate in areas of high prevalence of metronidazole resistance. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/10086657/One_week_ranitidine_bismuth_citrate_versus_colloidal_bismuth_subcitrate_based_anti_Helicobacter_triple_therapy:_a_prospective_randomized_controlled_trial_ L2 - http://Insights.ovid.com/pubmed?pmid=10086657 DB - PRIME DP - Unbound Medicine ER -