Jj. Kolkman et al., RANITIDINE BISMUTH CITRATE WITH CLARITHROMYCIN VERSUS OMEPRAZOLE WITHAMOXICILLIN IN THE CURE OF HELICOBACTER-PYLORI INFECTION, Alimentary pharmacology & therapeutics, 11(6), 1997, pp. 1123-1129
Aim: To compare the efficacy of ranitidine bismuth citrate plus clarit
hromycin (RBC-C) os. omeprazole plus amoxycillin (OME-AMO) in the cure
of Helicobacter pylori infection. Methods: In this double-blind, mult
icentre, parallel-group study 122 H. pylori-positive patients with act
ive duodenal ulcer or gastritis, with confirmed history of duodenal ul
cer, were randomized to treatment with ranitidine bismuth citrate 400
mg b.d. plus clarithromycin 500 mg b.d. or omeprazole 20 mg b.d. plus
amoxycillin 1000 mg b.d. for 14 days, followed by 14 days of ranitidin
e bismuth citrate 400 mg b.d. or omeprazole 20 mg once daily, respecti
vely, to facilitate ulcer healing. Endoscopy was carried out at the st
art of the study and 28 days after: the end of treatment. At each endo
scopy four biopsies were obtained from the antrum and four biopsies fr
om the corpus, for rapid urease test, histology and culture. H. pylori
infection was defined as a positive urease test, confirmed by histolo
gy or culture. Cure of H, pylori infection was defined as negative ure
ase test, histology or culture from both sites. Results: Per-protocol,
all-patients-treated and intention-to-treat cure rates (95% confidenc
e interval) were, respectively 90% (81-89%), 90% (82-89%) and 84% (74-
93%) for ranitidine bismuth citrate plus clarithromycin, and 39% (27-5
4%), 44% (31-57%) and 41% (29-53%) for omeprazole plus amoxycillin, P
< 0.00001. Both regimens were well tolerated. Eight patients were lost
to follow-up, for lack of efficacy (one patient), adverse events (thr
ee patients) or refusal of second endoscopy (four patients). Conclusio
n: Ranitidine bismuth citrate 400 mg b.d. with clarithromycin 500 mg b
.d. is superior to omeprazole 20 mg b.d. with amoxycillin 1000 mg b.d.
Ranitidine bismuth citrate with clarithromycin is the first dual ther
apy with high cure rates and good tolerance, and is easy to take. It m
ay therefore prove a suitable first-line treatment in H. pylori infect
ion.