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Helicobacter pylori eradication with proton pump inhibitor-based triple therapies and re-treatment with ranitidine bismuth citrate-based triple therapy.
Aliment Pharmacol Ther 1999; 13(2):163-8AP

Abstract

BACKGROUND

It has been suggested that short-term triple therapy comprising a proton pump inhibitor, plus clarithromycin and amoxycillin be used as first choice in treating H. pylori infection, while eradication failure patients should be further treated with a quadruple therapy. Nevertheless, conflicting results have been reported using these treatment regimens in different countries.

METHODS

A total of 278 patients with H. pylori infection were randomised to receive one-week triple therapy, comprising clarithromycin 500 mg b.d., amoxycillin 1 g b.d., and either omeprazole 20 mg b.d. (OAC; 90 patients), or pantoprazole 40 mg b.d. (PAC; 95 patients), or lansoprazole 30 mg b.d. (LAC; 93 patients). H. pylori infection at entry, and eradication 4-6 weeks after therapy had ended, were assessed by rapid urease test and histology on biopsies from the antrum and the corpus. When eradication did not occur, patients were given a 2-week treatment comprising ranitidine bismuth citrate 400 mg b.d., tetracycline 500 mg t.d.s. and tinidazole 500 mg b.d. (RBTT). Eradication in these patients was assessed 4-6 weeks after conclusion of treatment by a further endoscopy.

RESULTS

Six patients were lost to the follow-up. At the end of the first course of treatment, the overall H. pylori eradication rate was 78% (95% CI: 73-83) and 79% (95% CI: 75-84) at 'intention-to-treat' (ITT) and 'per protocol' (PP) analysis, respectively, without any statistically significant difference between treatment regimens, although a trend for better results with the omeprazole combination was observed. Moreover, H. pylori eradication was achieved in 82% (95% CI: 75-97) (ITT) and 86% (95% CI: 69-94) (PP) of 38 patients re-treated with RBTT regimen.

CONCLUSIONS

Our data found that this short-term triple therapy is not a satisfactory treatment (< 80% eradication rate) for H. pylori infection. The 2-week triple therapy used as re-treatment in eradication failure patients yielded more promising results.

Authors+Show Affiliations

Department of Clinical Medicine, Gastroenterology II, 'La Sapienza' University, Rome, Italy.No 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
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

10102945

Citation

Rinaldi, V, et al. "Helicobacter Pylori Eradication With Proton Pump Inhibitor-based Triple Therapies and Re-treatment With Ranitidine Bismuth Citrate-based Triple Therapy." Alimentary Pharmacology & Therapeutics, vol. 13, no. 2, 1999, pp. 163-8.
Rinaldi V, Zullo A, De Francesco V, et al. Helicobacter pylori eradication with proton pump inhibitor-based triple therapies and re-treatment with ranitidine bismuth citrate-based triple therapy. Aliment Pharmacol Ther. 1999;13(2):163-8.
Rinaldi, V., Zullo, A., De Francesco, V., Hassan, C., Winn, S., Stoppino, V., ... Attili, A. F. (1999). Helicobacter pylori eradication with proton pump inhibitor-based triple therapies and re-treatment with ranitidine bismuth citrate-based triple therapy. Alimentary Pharmacology & Therapeutics, 13(2), pp. 163-8.
Rinaldi V, et al. Helicobacter Pylori Eradication With Proton Pump Inhibitor-based Triple Therapies and Re-treatment With Ranitidine Bismuth Citrate-based Triple Therapy. Aliment Pharmacol Ther. 1999;13(2):163-8. PubMed PMID: 10102945.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Helicobacter pylori eradication with proton pump inhibitor-based triple therapies and re-treatment with ranitidine bismuth citrate-based triple therapy. AU - Rinaldi,V, AU - Zullo,A, AU - De Francesco,V, AU - Hassan,C, AU - Winn,S, AU - Stoppino,V, AU - Faleo,D, AU - Attili,A F, PY - 1999/4/2/pubmed PY - 1999/4/2/medline PY - 1999/4/2/entrez SP - 163 EP - 8 JF - Alimentary pharmacology & therapeutics JO - Aliment. Pharmacol. Ther. VL - 13 IS - 2 N2 - BACKGROUND: It has been suggested that short-term triple therapy comprising a proton pump inhibitor, plus clarithromycin and amoxycillin be used as first choice in treating H. pylori infection, while eradication failure patients should be further treated with a quadruple therapy. Nevertheless, conflicting results have been reported using these treatment regimens in different countries. METHODS: A total of 278 patients with H. pylori infection were randomised to receive one-week triple therapy, comprising clarithromycin 500 mg b.d., amoxycillin 1 g b.d., and either omeprazole 20 mg b.d. (OAC; 90 patients), or pantoprazole 40 mg b.d. (PAC; 95 patients), or lansoprazole 30 mg b.d. (LAC; 93 patients). H. pylori infection at entry, and eradication 4-6 weeks after therapy had ended, were assessed by rapid urease test and histology on biopsies from the antrum and the corpus. When eradication did not occur, patients were given a 2-week treatment comprising ranitidine bismuth citrate 400 mg b.d., tetracycline 500 mg t.d.s. and tinidazole 500 mg b.d. (RBTT). Eradication in these patients was assessed 4-6 weeks after conclusion of treatment by a further endoscopy. RESULTS: Six patients were lost to the follow-up. At the end of the first course of treatment, the overall H. pylori eradication rate was 78% (95% CI: 73-83) and 79% (95% CI: 75-84) at 'intention-to-treat' (ITT) and 'per protocol' (PP) analysis, respectively, without any statistically significant difference between treatment regimens, although a trend for better results with the omeprazole combination was observed. Moreover, H. pylori eradication was achieved in 82% (95% CI: 75-97) (ITT) and 86% (95% CI: 69-94) (PP) of 38 patients re-treated with RBTT regimen. CONCLUSIONS: Our data found that this short-term triple therapy is not a satisfactory treatment (< 80% eradication rate) for H. pylori infection. The 2-week triple therapy used as re-treatment in eradication failure patients yielded more promising results. SN - 0269-2813 UR - https://www.unboundmedicine.com/medline/citation/10102945/Helicobacter_pylori_eradication_with_proton_pump_inhibitor_based_triple_therapies_and_re_treatment_with_ranitidine_bismuth_citrate_based_triple_therapy_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&amp;sid=nlm:pubmed&amp;issn=0269-2813&amp;date=1999&amp;volume=13&amp;issue=2&amp;spage=163 DB - PRIME DP - Unbound Medicine ER -