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Seven-day 'rescue' therapy after Helicobacter pylori treatment failure: omeprazole, bismuth, tetracycline and metronidazole vs. ranitidine bismuth citrate, tetracycline and metronidazole.
Aliment Pharmacol Ther 1999; 13(10):1311-6AP

Abstract

BACKGROUND

Eradication therapy with omeprazole (O), amoxycillin (A) and clarithromycin (C) is used extensively, although it often fails. A 'rescue' therapy with a quadruple combination of O, bismuth (B), tetracycline (T) and metronidazole (M) has been recommended.

AIM

: To assess ranitidine bismuth citrate (Rbc) instead of O and B for treatment failure.

METHODS

Sixty consecutive patients (13 duodenal ulcer, 47 non-ulcer dyspepsia) in whom a previous eradication trial with O, A and C had failed were randomized to receive one of two regimens for 7 days: O (20 mg b.d.), B (120 mg q. d.s.), T (500 mg q.d.s.) and M (250 mg q.d.s.) (group OBTM, n=30); or Rbc (400 mg b.d.), T (500 mg q.d.s.) and M (250 mg q.d.s.) (group RbcTM, n=30). Eradication was defined as a negative 13C-urea breath test 1 month after completing therapy.

RESULTS

Mean age +/- s.d. was 45 +/- 12 years, 47% were males. Distribution of studied variables (age, sex, smoking, duodenal ulcer/non-ulcer dyspepsia) was similar in both therapeutic groups. Per protocol eradication was achieved in 17 out of 29 patients (59%) in group OBTM and in 25 out of 29 patients (86%) in group RbcTM (P < 0.05). Intention-to-treat eradication was achieved, respectively, in 17 out of 30 (57%) and in 25 out of 30 (83%) (P < 0.05). In the multivariate analysis the variables which influenced on H. pylori eradication were the type of therapy (odds ratio, OR=3.9; 95%CI: 1.02-15; P < 0.05) and diagnosis (duodenal ulcer/non-ulcer dyspepsia) (OR=0.1; CI: 0.02-0.4). Adverse effects were infrequent and mild with both regimens.

CONCLUSION

Therapy with RbcTM is a promising option after H. pylori eradication failure with OCA, achieving a higher efficacy than quadruple therapy with OBTM.

Authors+Show Affiliations

Department of Gastroenterology, University Hospital of 'La Princesa', Madrid, Spain. gisbert@meditex.es

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

10540045

Citation

Gisbert, J P., et al. "Seven-day 'rescue' Therapy After Helicobacter Pylori Treatment Failure: Omeprazole, Bismuth, Tetracycline and Metronidazole Vs. Ranitidine Bismuth Citrate, Tetracycline and Metronidazole." Alimentary Pharmacology & Therapeutics, vol. 13, no. 10, 1999, pp. 1311-6.
Gisbert JP, Gisbert JL, Marcos S, et al. Seven-day 'rescue' therapy after Helicobacter pylori treatment failure: omeprazole, bismuth, tetracycline and metronidazole vs. ranitidine bismuth citrate, tetracycline and metronidazole. Aliment Pharmacol Ther. 1999;13(10):1311-6.
Gisbert, J. P., Gisbert, J. L., Marcos, S., Grávalos, R. G., Carpio, D., & Pajares, J. M. (1999). Seven-day 'rescue' therapy after Helicobacter pylori treatment failure: omeprazole, bismuth, tetracycline and metronidazole vs. ranitidine bismuth citrate, tetracycline and metronidazole. Alimentary Pharmacology & Therapeutics, 13(10), pp. 1311-6.
Gisbert JP, et al. Seven-day 'rescue' Therapy After Helicobacter Pylori Treatment Failure: Omeprazole, Bismuth, Tetracycline and Metronidazole Vs. Ranitidine Bismuth Citrate, Tetracycline and Metronidazole. Aliment Pharmacol Ther. 1999;13(10):1311-6. PubMed PMID: 10540045.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Seven-day 'rescue' therapy after Helicobacter pylori treatment failure: omeprazole, bismuth, tetracycline and metronidazole vs. ranitidine bismuth citrate, tetracycline and metronidazole. AU - Gisbert,J P, AU - Gisbert,J L, AU - Marcos,S, AU - Grávalos,R G, AU - Carpio,D, AU - Pajares,J M, PY - 1999/10/30/pubmed PY - 1999/10/30/medline PY - 1999/10/30/entrez SP - 1311 EP - 6 JF - Alimentary pharmacology & therapeutics JO - Aliment. Pharmacol. Ther. VL - 13 IS - 10 N2 - BACKGROUND: Eradication therapy with omeprazole (O), amoxycillin (A) and clarithromycin (C) is used extensively, although it often fails. A 'rescue' therapy with a quadruple combination of O, bismuth (B), tetracycline (T) and metronidazole (M) has been recommended. AIM: : To assess ranitidine bismuth citrate (Rbc) instead of O and B for treatment failure. METHODS: Sixty consecutive patients (13 duodenal ulcer, 47 non-ulcer dyspepsia) in whom a previous eradication trial with O, A and C had failed were randomized to receive one of two regimens for 7 days: O (20 mg b.d.), B (120 mg q. d.s.), T (500 mg q.d.s.) and M (250 mg q.d.s.) (group OBTM, n=30); or Rbc (400 mg b.d.), T (500 mg q.d.s.) and M (250 mg q.d.s.) (group RbcTM, n=30). Eradication was defined as a negative 13C-urea breath test 1 month after completing therapy. RESULTS: Mean age +/- s.d. was 45 +/- 12 years, 47% were males. Distribution of studied variables (age, sex, smoking, duodenal ulcer/non-ulcer dyspepsia) was similar in both therapeutic groups. Per protocol eradication was achieved in 17 out of 29 patients (59%) in group OBTM and in 25 out of 29 patients (86%) in group RbcTM (P < 0.05). Intention-to-treat eradication was achieved, respectively, in 17 out of 30 (57%) and in 25 out of 30 (83%) (P < 0.05). In the multivariate analysis the variables which influenced on H. pylori eradication were the type of therapy (odds ratio, OR=3.9; 95%CI: 1.02-15; P < 0.05) and diagnosis (duodenal ulcer/non-ulcer dyspepsia) (OR=0.1; CI: 0.02-0.4). Adverse effects were infrequent and mild with both regimens. CONCLUSION: Therapy with RbcTM is a promising option after H. pylori eradication failure with OCA, achieving a higher efficacy than quadruple therapy with OBTM. SN - 0269-2813 UR - https://www.unboundmedicine.com/medline/citation/10540045/Seven_day_'rescue'_therapy_after_Helicobacter_pylori_treatment_failure:_omeprazole_bismuth_tetracycline_and_metronidazole_vs__ranitidine_bismuth_citrate_tetracycline_and_metronidazole_ 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=10&amp;spage=1311 DB - PRIME DP - Unbound Medicine ER -