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One-week ranitidine bismuth citrate in combinations with metronidazole, amoxycillin and clarithromycin in the treatment of Helicobacter pylori infection: the RBC-MACH study.
Aliment Pharmacol Ther 1999; 13(8):1079-84AP

Abstract

BACKGROUND

We have previously shown that ranitidine bismuth citrate (RBC)-based triple therapy is comparable to proton pump inhibitor-based triple therapy in eradicating Helicobacter pylori infection.

AIM

To test the efficacy of different combinations of antimicrobials with RBC in the treatment of H. pylori infection.

METHODS

Dyspeptic patients with H. pylori infection were prospectively randomized to receive one of the following regimens: (i) RBC 400 mg, amoxycillin 1 g, clarithromycin 500 mg [RAC]; (ii) RBC 400 mg, metronidazole 400 mg, clarithromycin 500 mg [RMC]; (iii) RBC 400 mg, metronidazole 400 mg, tetracycline 1 g [RMT] (all given twice daily for 1 week); or (iv) RBC 400 mg plus clarithromycin 500 mg twice daily for 2 weeks [RC-2]. Endoscopy (rapid urease test and culture) and 13C-urea breath test (UBT) were performed before randomization. Four weeks after finishing medication, the 13C-UBT was repeated in all cases and endoscopy was offered to patients with peptic ulcers.

RESULTS

Four hundred patients were randomized but in two (one in the RAC group and one in the RMC group) H. pylori infection was not confirmed. Successful eradication of H. pylori (intention-to-treat analysis and 95% CI) of RAC (86% [79-93%]), RMC (90% [84-96%]), RMT (79% [71-87%]) and RC-2 (82% [75-90%]) were comparable, with a trend favouring clarithromycin-containing triple therapy regimens. Among 276 isolates tested for antibiotic sensitivity, primary resistance to metronidazole, clarithromycin and amoxycillin was found in 56%, 2% and 0.4%, respectively. When given RMC or RMT, patients infected by metronidazole-resistant H. pylori had success in eradicating H. pylori similar to patients infected by metronidazole-sensitive H. pylori.

CONCLUSION

One-week RBC triple therapy is effective in curing H. pylori infection.

Authors+Show Affiliations

Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong. joesung@cuhk.edu.hkNo 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
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10468684

Citation

Sung, J J., et al. "One-week Ranitidine Bismuth Citrate in Combinations With Metronidazole, Amoxycillin and Clarithromycin in the Treatment of Helicobacter Pylori Infection: the RBC-MACH Study." Alimentary Pharmacology & Therapeutics, vol. 13, no. 8, 1999, pp. 1079-84.
Sung JJ, Chan FK, Wu JC, et al. One-week ranitidine bismuth citrate in combinations with metronidazole, amoxycillin and clarithromycin in the treatment of Helicobacter pylori infection: the RBC-MACH study. Aliment Pharmacol Ther. 1999;13(8):1079-84.
Sung, J. J., Chan, F. K., Wu, J. C., Leung, W. K., Suen, R., Ling, T. K., ... Chung, S. C. (1999). One-week ranitidine bismuth citrate in combinations with metronidazole, amoxycillin and clarithromycin in the treatment of Helicobacter pylori infection: the RBC-MACH study. Alimentary Pharmacology & Therapeutics, 13(8), pp. 1079-84.
Sung JJ, et al. One-week Ranitidine Bismuth Citrate in Combinations With Metronidazole, Amoxycillin and Clarithromycin in the Treatment of Helicobacter Pylori Infection: the RBC-MACH Study. Aliment Pharmacol Ther. 1999;13(8):1079-84. PubMed PMID: 10468684.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - One-week ranitidine bismuth citrate in combinations with metronidazole, amoxycillin and clarithromycin in the treatment of Helicobacter pylori infection: the RBC-MACH study. AU - Sung,J J, AU - Chan,F K, AU - Wu,J C, AU - Leung,W K, AU - Suen,R, AU - Ling,T K, AU - Lee,Y T, AU - Cheng,A F, AU - Chung,S C, PY - 1999/9/1/pubmed PY - 1999/9/1/medline PY - 1999/9/1/entrez SP - 1079 EP - 84 JF - Alimentary pharmacology & therapeutics JO - Aliment. Pharmacol. Ther. VL - 13 IS - 8 N2 - BACKGROUND: We have previously shown that ranitidine bismuth citrate (RBC)-based triple therapy is comparable to proton pump inhibitor-based triple therapy in eradicating Helicobacter pylori infection. AIM: To test the efficacy of different combinations of antimicrobials with RBC in the treatment of H. pylori infection. METHODS: Dyspeptic patients with H. pylori infection were prospectively randomized to receive one of the following regimens: (i) RBC 400 mg, amoxycillin 1 g, clarithromycin 500 mg [RAC]; (ii) RBC 400 mg, metronidazole 400 mg, clarithromycin 500 mg [RMC]; (iii) RBC 400 mg, metronidazole 400 mg, tetracycline 1 g [RMT] (all given twice daily for 1 week); or (iv) RBC 400 mg plus clarithromycin 500 mg twice daily for 2 weeks [RC-2]. Endoscopy (rapid urease test and culture) and 13C-urea breath test (UBT) were performed before randomization. Four weeks after finishing medication, the 13C-UBT was repeated in all cases and endoscopy was offered to patients with peptic ulcers. RESULTS: Four hundred patients were randomized but in two (one in the RAC group and one in the RMC group) H. pylori infection was not confirmed. Successful eradication of H. pylori (intention-to-treat analysis and 95% CI) of RAC (86% [79-93%]), RMC (90% [84-96%]), RMT (79% [71-87%]) and RC-2 (82% [75-90%]) were comparable, with a trend favouring clarithromycin-containing triple therapy regimens. Among 276 isolates tested for antibiotic sensitivity, primary resistance to metronidazole, clarithromycin and amoxycillin was found in 56%, 2% and 0.4%, respectively. When given RMC or RMT, patients infected by metronidazole-resistant H. pylori had success in eradicating H. pylori similar to patients infected by metronidazole-sensitive H. pylori. CONCLUSION: One-week RBC triple therapy is effective in curing H. pylori infection. SN - 0269-2813 UR - https://www.unboundmedicine.com/medline/citation/10468684/One_week_ranitidine_bismuth_citrate_in_combinations_with_metronidazole_amoxycillin_and_clarithromycin_in_the_treatment_of_Helicobacter_pylori_infection:_the_RBC_MACH_study_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0269-2813&date=1999&volume=13&issue=8&spage=1079 DB - PRIME DP - Unbound Medicine ER -