Review article: treatment of Helicobacter pylori infection with ranitidinebismuth citrate- or proton pump inhibitor-based triple therapies

Triple therapy, combining a proton pump inhibitor with clarithromycin (C) a nd either amoxycillin (A) or a nitroimidazole (I) is the standard in Helico bacter pylori eradication therapy. Recently, triple therapies based on rani tidine bismuth citrate (RBC) have emerged as an alternative. This review ex amines the current literature for studies directly comparing proton pump in hibitor-with RBC-based triple therapies. Seventeen studies were identified, of which three have been published as a full, paper. Eradication rates in an intention-to-treat analysis ranged from 51 to 98%, No large difference in cure rates between the different regimens was demons trated, although the RBC-I-C combination was somewhat superior. No definite conclusions could be made about the impact of metronidazole or clarithromy cin resistance since only three studies performed a formal resistance analy sis. No serious side-effects were reported, and dropout rates were equal fo r the two regimens. Both RBC-. and proton pump inhibitor-based triple therapies are highly effe ctive. If one prefers a imidazole/clarithromycin combination the evidence p resented here suggests that RBC should be used instead of a proton pump inh ibitor. Larger studies comparing both forms of triple therapy, using proper resistance analysis, are needed before final conclusions can be reached re garding efficacy in the setting of bacterial resistance.