One-week dual therapy with ranitidine bismuth citrate and clarithromycin for the treatment of Helicobacter pylori infection in Brazilian patients with peptic ulcer

AIM:To assess the efficacy and safety of ranitidine bismuth citrate plus clarithromycin given for 1 wk in Brazilian patients with peptic ulcer. METHODS: One hundred and twenty patients with peptic ulcer were randomized in two treatment groups: (1)1-wk regimen consisting of ranitidine bismuth citrate 400 mg b.i.d. with clarithromycin 500 mg b.i.d. or (2) 2-wk regimen of the same treatment. Eradication of the infection was considered when both the histologic examination and the urease test were negative for the infection 3 mo after treatment. RESULTS: By intention to treat analysis, Helicobacter pylori (H pylori) was eradicated in 73% and 76% of patients, respectively treated for 1 or 2 wk (P>0.05). By per protocol analysis, the eradication rates were 80% and 83%, respectively, in patients treated for 1 or 2 wk (P>0.05). Nine patients (8.2%) reported minor side effects. CONCLUSION: One-week therapy with ranitidine bismuth citrate and clarithromycin is safe, well tolerated and effective for treatment of H pylori infection, and appears to be comparable to the 2-wk regimen in terms of efficacy.x

First-line eradication of H pylori infection in Europe:A metaanalysis based on congress abstracts,1997-2004

AIM： To meta-analyse the European abstracts presented between 1997-2004 at the European Hpylori Study Group, United European Gastroenterology Week meetings and World Congresses of Gastroenterology. METHODS： The abstracts of randomized/controlled prospective studies were classified into groups based on first-line eradication schedules. The quality of the abstracts was checked by a validated score system. The pooled eradication rates （PER） and combined odds ratios （OR） were calculated and compared with the published meta-analyses. RESULTS： The PER of proton pump inhibitor-based （PPI） one week triple therapies was 81.4% （confidence interval, 95% CI： 78.5-84.5）. Ranitidine bismuth citratebased （RBC） triple regimens have an efficiency rate of 78.5% （95% CI： 70.5%-84.3%） （P = 0.28 vs PPI）. The OR for PPI effect vs RBC regimens was 1.1 （95% CI： 0.92-1.30）. H2 receptor antagonist-based triple therapies achieved 64.1% （95% CI： 52.6-75.6） （P = 0.02 〈 0.05 vs PPI）, the OR vs PPI regimens was 1.55 （95% CI： 0.72-3.78）. PPI-based double combinations were less efficient than triple regimens （PER： 55.0%, OR： 4.90, 95% CI： 2.36-9.70）. Quadruple regimens were successful in 82.6% （95% CI： 76.0-89.7）, the OR vs triple therapies was 0.80 （0.62-1.03）. Clarithromycin ＋ amoxicillin or nitroimidazole combinations were efficient in 80.5% （95% CI： 77.2-84.2） and 83.8% （95% CI： 81.7-85.9）, respectively. Amoxicillin ＋ nitromidazole therapies eradicated the infection in 73.5% （66.6-78.5） （P = 0.01 〈 0.05 vs clarithromycin-based regimens）. CONCLUSION： PPI/RBC-based triple therapies achieved comparable results with the meta-analyses. H2-receptor antagonists and PPI-based double combinations were less efficient. Triple and quadruple regimens were equally effective. Clarithmmycin ＋ either amoxicillin or nitroimidazole containing regimens were more effective than amoxicillin ＋ nitroimidazole combinations. High quality congress abstracts constitutes a valuable pool of data which is suitable for meta-analytical workup.