Tags

Type your tag names separated by a space and hit enter

Various durations of a standard regimen (amoxycillin, metronidazole, colloidal bismuth sub-citrate for 2 weeks or with additional ranitidine for 1 or 2 weeks) on eradication of Helicobacter pylori in Iranian peptic ulcer patients. A randomized controlled trial.
Eur J Gastroenterol Hepatol. 2001 Aug; 13(8):915-9.EJ

Abstract

INTRODUCTION

One of the most economical and effective therapeutic regimens for eradication of Helicobacter pylori is the classic triple therapy with amoxycillin or tetracycline, metronidazole and a bismuth derivative. Addition of H2-receptor antagonists to these drugs may heighten the rate of eradication and shorten the duration. We therefore performed a randomized controlled trial comparing twice daily metronidazole, bismuth derivative and amoxycillin for 2 weeks with additional ranitidine for 1 or 2 weeks.

PATIENTS AND METHODS

In total, 240 adult patients with duodenal ulcer and H. pylori infection were randomly assigned to one of the following regimens: (1) amoxycillin 1 g bid, metronidazole 500 mg bid, bismuth sub-citrate 240 mg bid and ranitidine 300 mg bid for 1 week; (2) triple therapy without ranitidine for 2 weeks; or (3) triple therapy plus ranitidine 300 mg bid for 2 weeks. Side-effects of the drugs were evaluated two weeks after starting the treatment. The rapid urease test and histology from antrum and corpus, and/or 14C- urea breath test were used to determine H. pylori eradication six weeks after starting the treatment.

RESULTS

In total, 195 patients were followed up for 6 weeks. The most frequent drug side-effects were unpleasant taste (46%), dry mouth (41%) and fatigue (26%), which had an equal distribution in all treatment groups. Endoscopy and 14C- urea breath test were performed for 178 and 123 patients, respectively. Eradication of H. pylori was documented in 19/64 (29.7%), 29/63 (46%) and 50/68 (73.5%) of patients in groups 1, 2 and 3, respectively (P < 0.000001 for group 1 versus group 3; P < 0.0014 for group 2 versus group 3; difference not significant for group 1 versus group 2). An intention-to-treat analysis showed eradication rates of 19/80 (23.75%), 29/80 (36.25%) and 50/80 (62.5%) for groups 1, 2 and 3, respectively. At four weeks post-treatment, the most sensitive test for evaluation of eradication of H. pylori was histology.

CONCLUSION

Although combined use of an H2-receptor antagonist and twice daily triple therapy in a two-week regimen is more effective than two-week triple or one-week quadruple therapy in Iranian patients, none of these regimens is ideal in countries with a probable high rate of resistant and strongly toxic strains of H. pylori.

Authors+Show Affiliations

Gastroenterology Division, Internal Medicine Ward, Shiraz University of Medical Sciences, Shiraz, Iran. kavianim@pearl.sums.ac.irNo 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

11507355

Citation

Kaviani, M J., et al. "Various Durations of a Standard Regimen (amoxycillin, Metronidazole, Colloidal Bismuth Sub-citrate for 2 Weeks or With Additional Ranitidine for 1 or 2 Weeks) On Eradication of Helicobacter Pylori in Iranian Peptic Ulcer Patients. a Randomized Controlled Trial." European Journal of Gastroenterology & Hepatology, vol. 13, no. 8, 2001, pp. 915-9.
Kaviani MJ, Malekzadeh R, Vahedi H, et al. Various durations of a standard regimen (amoxycillin, metronidazole, colloidal bismuth sub-citrate for 2 weeks or with additional ranitidine for 1 or 2 weeks) on eradication of Helicobacter pylori in Iranian peptic ulcer patients. A randomized controlled trial. Eur J Gastroenterol Hepatol. 2001;13(8):915-9.
Kaviani, M. J., Malekzadeh, R., Vahedi, H., Sotoudeh, M., Kamalian, N., Amini, M., & Massarrat, S. (2001). Various durations of a standard regimen (amoxycillin, metronidazole, colloidal bismuth sub-citrate for 2 weeks or with additional ranitidine for 1 or 2 weeks) on eradication of Helicobacter pylori in Iranian peptic ulcer patients. A randomized controlled trial. European Journal of Gastroenterology & Hepatology, 13(8), 915-9.
Kaviani MJ, et al. Various Durations of a Standard Regimen (amoxycillin, Metronidazole, Colloidal Bismuth Sub-citrate for 2 Weeks or With Additional Ranitidine for 1 or 2 Weeks) On Eradication of Helicobacter Pylori in Iranian Peptic Ulcer Patients. a Randomized Controlled Trial. Eur J Gastroenterol Hepatol. 2001;13(8):915-9. PubMed PMID: 11507355.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Various durations of a standard regimen (amoxycillin, metronidazole, colloidal bismuth sub-citrate for 2 weeks or with additional ranitidine for 1 or 2 weeks) on eradication of Helicobacter pylori in Iranian peptic ulcer patients. A randomized controlled trial. AU - Kaviani,M J, AU - Malekzadeh,R, AU - Vahedi,H, AU - Sotoudeh,M, AU - Kamalian,N, AU - Amini,M, AU - Massarrat,S, PY - 2001/8/17/pubmed PY - 2001/9/28/medline PY - 2001/8/17/entrez SP - 915 EP - 9 JF - European journal of gastroenterology & hepatology JO - Eur J Gastroenterol Hepatol VL - 13 IS - 8 N2 - INTRODUCTION: One of the most economical and effective therapeutic regimens for eradication of Helicobacter pylori is the classic triple therapy with amoxycillin or tetracycline, metronidazole and a bismuth derivative. Addition of H2-receptor antagonists to these drugs may heighten the rate of eradication and shorten the duration. We therefore performed a randomized controlled trial comparing twice daily metronidazole, bismuth derivative and amoxycillin for 2 weeks with additional ranitidine for 1 or 2 weeks. PATIENTS AND METHODS: In total, 240 adult patients with duodenal ulcer and H. pylori infection were randomly assigned to one of the following regimens: (1) amoxycillin 1 g bid, metronidazole 500 mg bid, bismuth sub-citrate 240 mg bid and ranitidine 300 mg bid for 1 week; (2) triple therapy without ranitidine for 2 weeks; or (3) triple therapy plus ranitidine 300 mg bid for 2 weeks. Side-effects of the drugs were evaluated two weeks after starting the treatment. The rapid urease test and histology from antrum and corpus, and/or 14C- urea breath test were used to determine H. pylori eradication six weeks after starting the treatment. RESULTS: In total, 195 patients were followed up for 6 weeks. The most frequent drug side-effects were unpleasant taste (46%), dry mouth (41%) and fatigue (26%), which had an equal distribution in all treatment groups. Endoscopy and 14C- urea breath test were performed for 178 and 123 patients, respectively. Eradication of H. pylori was documented in 19/64 (29.7%), 29/63 (46%) and 50/68 (73.5%) of patients in groups 1, 2 and 3, respectively (P < 0.000001 for group 1 versus group 3; P < 0.0014 for group 2 versus group 3; difference not significant for group 1 versus group 2). An intention-to-treat analysis showed eradication rates of 19/80 (23.75%), 29/80 (36.25%) and 50/80 (62.5%) for groups 1, 2 and 3, respectively. At four weeks post-treatment, the most sensitive test for evaluation of eradication of H. pylori was histology. CONCLUSION: Although combined use of an H2-receptor antagonist and twice daily triple therapy in a two-week regimen is more effective than two-week triple or one-week quadruple therapy in Iranian patients, none of these regimens is ideal in countries with a probable high rate of resistant and strongly toxic strains of H. pylori. SN - 0954-691X UR - https://www.unboundmedicine.com/medline/citation/11507355/Various_durations_of_a_standard_regimen__amoxycillin_metronidazole_colloidal_bismuth_sub_citrate_for_2_weeks_or_with_additional_ranitidine_for_1_or_2_weeks__on_eradication_of_Helicobacter_pylori_in_Iranian_peptic_ulcer_patients__A_randomized_controlled_trial_ L2 - http://dx.doi.org/10.1097/00042737-200108000-00007 DB - PRIME DP - Unbound Medicine ER -