METRONIDAZOLE, RANITIDINE AND CLARITHROMYCIN COMBINATION FOR TREATMENT OF HELICOBACTER-PYLORI INFECTION (MODIFIED BAZZOLIS TRIPLE THERAPY)

Background: Multi-drug regimens are generally required to reliably cur e Helicobacter pylori infection, Metronidazole, clarithromycin and ome prazole has proven to be an effective combination therapy with a cure rate of 90% or greater. Methods: We evaluated a 14-day combination reg imen for H, pylori infection consisting of metronidazole 500 mg b.d., clarithromycin 250 mg b.d. and ranitidine 300 mg b.d, (MRC) instead of omeprazole, Ranitidine alone was continued for an additional 4 weeks, H, pylori status was determined by rapid urease testing, histopatholo gy using the Genta stain, and by culture at entry and 4 weeks after co mpleting antimicrobial therapy. Results: Twenty-seven patients with do cumented peptic ulcer disease and H. pylori infection were treated. Fi ve had previously failed macrolide-based antimicrobial therapy; none h ad received metronidazole. All ulcers were healed at week 6 except one patient taking naproxen; his H, pylori infection was cured, Overall, H. pylori infection was cured in 78% (95% CI = 58-91%). In patients wi th clarithromycin-sensitive isolates, the cure rate was 20 of 23 (87%, 95% C.I. = 66-97%); only one of four patients (25%) with clarithromyc in-resistant isolates was cured, In contrast, four of five patients wi th metronidazole-resistant isolates were cured (80%), In patients with isolates sensitive to both antibiotics, the cure rate was 16 of 18 (8 9%, 95% C.I. = 65-99%), Mild side effects were reported by 27%, includ ing diarrhoea and altered taste. Compliance averaged 98%. Conclusion: These results suggest that the combination of metronidazole, ranitidin e and clarithromycin results in high cure rates in patients with clari thromycinsensitive isolates, Omeprazole may not be required for Bazzol i's triple therapy; and large multicentre comparative trials are indic ated.