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7-day rescue therapy with ranitidine bismuth citrate after Helicobacter pylori treatment failure.
Aliment Pharmacol Ther 2005; 21(10):1249-53AP

Abstract

BACKGROUND

Quadruple rescue therapy requires a complex scheme with four drugs.

AIM

To evaluate the efficacy of ranitidine bismuth citrate-tetracycline-metronidazole rescue regimen, and to compare two different metronidazole dose schemes.

METHODS

Prospective multicentre study including proton-pump inhibitor + clarithromycin + amoxicillin failures. Rescue regimen included two 7-day treatment: (i) ranitidine bismuth citrate (400 mg b.d.)-tetracycline (500 mg q.d.s.)-metronidazole (500 mg t.d.s.; RTM1); or (ii) the same regimen but with metronidazole 250 mg q.d.s. (RTM2). Eradication was confirmed with (13)C-urea breath test.

RESULTS

A total of 150 patients were included (58 RTM1, 92 RTM2). All patients but two (one in each group) returned after treatment. About 86% in group RTM1 and 95% in RTM2 correctly took all the medications (P = 0.076). Per-protocol eradication rates with RTM1 and RTM2 were 74 (95% CI: 60-84) and 69% (59-78). The intention-to-treat eradication rates were 64 (51-75) and 70% (59-78; P > 0.05). The type of regimen was not associated with eradication in the multivariate analysis. Adverse effects were more frequent with RTM1 (41%) than with RTM2 (30%; P > 0.05).

CONCLUSION

Seven-day triple rescue therapy with ranitidine bismuth citrate-tetracycline-metronidazole is effective for Helicobacter pylori eradication, and represents an encouraging alternative to quadruple therapy, with the advantage of simplicity. The administration of metronidazole every 6 h (together with tetracycline), and at a low dose (250 mg), achieves similar efficacy and is probably associated with a better compliance and a lower incidence of adverse effects.

Authors+Show Affiliations

Servicio de Aparato Digestivo, Hospital Universitario de la Princesa, Madrid, Spain. gisbert@meditex.esNo 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
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15882246

Citation

Gisbert, J P., et al. "7-day Rescue Therapy With Ranitidine Bismuth Citrate After Helicobacter Pylori Treatment Failure." Alimentary Pharmacology & Therapeutics, vol. 21, no. 10, 2005, pp. 1249-53.
Gisbert JP, Fuentes J, Carpio D, et al. 7-day rescue therapy with ranitidine bismuth citrate after Helicobacter pylori treatment failure. Aliment Pharmacol Ther. 2005;21(10):1249-53.
Gisbert, J. P., Fuentes, J., Carpio, D., Tito, L., Guardiola, J., Tomas, A., ... Calvet, X. (2005). 7-day rescue therapy with ranitidine bismuth citrate after Helicobacter pylori treatment failure. Alimentary Pharmacology & Therapeutics, 21(10), pp. 1249-53.
Gisbert JP, et al. 7-day Rescue Therapy With Ranitidine Bismuth Citrate After Helicobacter Pylori Treatment Failure. Aliment Pharmacol Ther. 2005 May 15;21(10):1249-53. PubMed PMID: 15882246.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 7-day rescue therapy with ranitidine bismuth citrate after Helicobacter pylori treatment failure. AU - Gisbert,J P, AU - Fuentes,J, AU - Carpio,D, AU - Tito,L, AU - Guardiola,J, AU - Tomas,A, AU - Olivares,D, AU - Calvet,X, PY - 2005/5/11/pubmed PY - 2005/8/17/medline PY - 2005/5/11/entrez SP - 1249 EP - 53 JF - Alimentary pharmacology & therapeutics JO - Aliment. Pharmacol. Ther. VL - 21 IS - 10 N2 - BACKGROUND: Quadruple rescue therapy requires a complex scheme with four drugs. AIM: To evaluate the efficacy of ranitidine bismuth citrate-tetracycline-metronidazole rescue regimen, and to compare two different metronidazole dose schemes. METHODS: Prospective multicentre study including proton-pump inhibitor + clarithromycin + amoxicillin failures. Rescue regimen included two 7-day treatment: (i) ranitidine bismuth citrate (400 mg b.d.)-tetracycline (500 mg q.d.s.)-metronidazole (500 mg t.d.s.; RTM1); or (ii) the same regimen but with metronidazole 250 mg q.d.s. (RTM2). Eradication was confirmed with (13)C-urea breath test. RESULTS: A total of 150 patients were included (58 RTM1, 92 RTM2). All patients but two (one in each group) returned after treatment. About 86% in group RTM1 and 95% in RTM2 correctly took all the medications (P = 0.076). Per-protocol eradication rates with RTM1 and RTM2 were 74 (95% CI: 60-84) and 69% (59-78). The intention-to-treat eradication rates were 64 (51-75) and 70% (59-78; P > 0.05). The type of regimen was not associated with eradication in the multivariate analysis. Adverse effects were more frequent with RTM1 (41%) than with RTM2 (30%; P > 0.05). CONCLUSION: Seven-day triple rescue therapy with ranitidine bismuth citrate-tetracycline-metronidazole is effective for Helicobacter pylori eradication, and represents an encouraging alternative to quadruple therapy, with the advantage of simplicity. The administration of metronidazole every 6 h (together with tetracycline), and at a low dose (250 mg), achieves similar efficacy and is probably associated with a better compliance and a lower incidence of adverse effects. SN - 0269-2813 UR - https://www.unboundmedicine.com/medline/citation/15882246/7_day_rescue_therapy_with_ranitidine_bismuth_citrate_after_Helicobacter_pylori_treatment_failure_ L2 - https://doi.org/10.1111/j.1365-2036.2005.02465.x DB - PRIME DP - Unbound Medicine ER -