Seven-day 'rescue' therapy after Helicobacter pylori treatment failure: omeprazole, bismuth, tetracycline and metronidazole vs. ranitidine bismuth citrate, tetracycline and metronidazole

Background: Eradication therapy with omeprazole (O), amoxycillin (A) and cl arithromycin (C) is used extensively, although it often fails. A 'rescue' t herapy with a quadruple combination of O, bismuth (B), tetracycline (T) and metronidazole (Rif) has been recommended, Aim: To assess ranitidine bismuth citrate (Rbc) instead of O and B for trea tment failure. Methods: Sixty consecutive patients (13 duodenal ulcer, 47 non-ulcer dyspep sia) in whom a previous eradication trial with O, A and C had failed were r andomized to receive one of two regimens for 7 days: O (20 mg b.d.), B (120 mg q.d.s.), T (500 mg q.d.s.) and M (250 mg q.d.s.) (group OBTM, n = 30); or Rbc (400 mg b.d,), T (500 mg q.d.s.) and M (250 mg q.d.s.) (group RbcTM, n = 30). Eradication was defined as a negative C-13-urea breath test 1 mon th after completing therapy, Results: Mean age +/- s.d. was 45 +/- 12 years, 47% were males. Distributio n of studied variables (age, sex, smoking, duodenal ulcer/non-ulcer dyspeps ia) was similar in both therapeutic groups. Per protocol eradication was ac hieved in 17 out of 29 patients (59%) in group OBTM and in 25 out of 29 pat ients (86%) in group RbcTM (P < 0.05). Intention-to-treat eradication was a chieved, respectively, in 1 7 out of 30 (57%) and in 25 out of 30 (83%) (P < 0.05). In the multivariate analysis the variables which influenced on H, pylori eradication were the type of therapy (odds ratio, OR = 3.9; 95%CI: 1 .02-15; P < 0.05) and diagnosis (duodenal ulcer/non-ulcer dyspepsia) (OR = 0.1; CI: 0.02-0.4). Adverse effects were infrequent and mild with both regi mens. Conclusion: Therapy with RbcTM is a promising option after H. pylori eradic ation failure with OCA, achieving a higher efficacy than quadruple therapy with OBTM.