Ranitidine bismuth citrate, tetracycline, clarithromycin twice-a-day triple therapy for clarithromycin susceptible Helicobacter pylori infection

Background: Although many combination therapies have been proposed, there i s still interest in identifying simple, inexpensive, effective protocols th at have high rates of success. Aim: To investigate the role of the new soluble form of bismuth, ranitidine bismuth citrate, in twice-a-day therapy for Helicobacter pylori infection, Methods: Patients with histologically and culture proven H. pylori infectio n received ranitidine bismuth citrate 400 mg, tetracycline HCl 500 mg, and clarithromycin 500 mg, each b.d. for 14 days, followed by 300 mg ranitidine once a day for 4 additional weeks, Outcome was assessed 4 or more weeks af ter the end of antimicrobial therapy by repeat endoscopy with histology and culture (49 patients) or urea breath testing (14 patients), Results: Sixty -three patients completed the therapy, 59 men and four women (average age 5 6.7 years; range 31-75 years). All patients had clarithromycin-susceptible strains prior to therapy. H. pylori infection was cured in 94% (95% CI: 85- 98%), There was a therapy failure in one patient who took. the medicine for only 1 day and stopped because of side-effects. Three of the isolates from treatment failures were available post-failure; two were clarithromycin-re sistant and one was susceptible. Side-effects were severe in two patients ( 3%) and moderate in three (primarily diarrhoea). Conclusions: Twice-a-day ranitidine bismuth citrate, tetracycline, clarithr omycin triple therapy was well tolerated and effective for the treatment of H. pylori infection in patients with clarithromycin-susceptible H. pylori.