The influence of metronidazole resistance on the efficacy of ranitidine bismuth citrate triple therapy regimens for Helicobacter pylori infection

Aim: To assess the influence of metronidazole resistance on the efficacy of ranitidine bismuth citrate-based triple therapy regimens in two consecutiv e studies. Methods: In the first study, patients with a culture-proven Helicobacter py lori infection were treated with ranitidine bismuth citrate 400 mg, metroni dazole 500 mg, and clarithromycin 500 mg, all twice dairy for 1 week (RMC). In the second study, amoxycillin 1000 mg was substituted for clarithromyci n (RMA). Susceptibility testing for metronidazole was performed with the E- test. Follow-up endoscopy was performed after greater than or equal to 4 we eks. Antral biopsy samples were taken for histology and urease test, and cu lture and corpus samples for histology and culture. Results: 112 patients, 53 males, age 55 +/- 14 years (39 duodenal ulcer, 7 gastric ulcer and 66 gastritis) were treated with RMC, and 89 patients, 52 males, age 58 +/- 15 years (23 duodenal ulcer, 7 gastric ulcer and 59 gastr itis) were treated with RMA. For RMC, intention-to-treat eradication result s were 98% (59/60, 95% CI: 91-100%) and 95% (20/21, 95% CI: 76-100%) for me tronidazoIe susceptible and resistant strains, respectively (P = 0.45). For RMA these figures were 87% (53/61, 95% CT: 76-94%) for metronidazole susce ptible strains and 22% (2/9, 95% CI: 3-60%) for resistant strains (P = 0.00 01). Conclusion: Both regimens are effective in metronidazole susceptible strain s. However, in contrast to the amoxycillin-containing regimen, that contain ing clarithromycin is also effective in resistant strains.