title: Clarithromycin, tetracycline, and bismuth: a new non-metronidazole therapy for Helicobacter pylori infection.
abstract: OBJECTIVE
  Metronidazole resistance has become an increasing problem that has limited the usefulness of the original triple therapy. Our objective was to evaluate clarithromycin, a new macrolide compound active against Helicobacter pylori.
  
  
  METHODS
  We evaluated a new clarithromycin triple therapy for H. pylori infection consisting of the combination of clarithromycin (500 mg t.i.d.), tetracycline (500 mg q.i.d.), and bismuth subsalicylate tablets (2 q.i.d.) for 14 days. Patients with ulcer also received concomitant ranitidine, 300 mg after the evening meal, for 6 wk.
  
  
  RESULTS
  Thirty men with documented H. pylori infection were studied; 29 had peptic ulcer disease. Seven had previously failed antimicrobial therapy, including three with metronidazole-based triple therapy. H. pylori status was determined by histology. H. pylori status and ulcer status were evaluated 4 wk after the end of antimicrobial therapy. The ulcer was healed in 90%. The H. pylori infection was cured in 93%, including all three patients who previously failed metronidazole-based triple therapy.
  
  
  CONCLUSIONS
  We conclude that the combination of clarithromycin, tetracycline, and bismuth is an effective new therapy for treatment of H. pylori infection.
authors.affiliation: Department of Medicine, Veterans Affairs Medical Center, Houston, Texas.
authors.forename: M T
authors.initials: MT
authors.lastname: al-Assi
authors.forename: F C
authors.initials: FC
authors.lastname: Ramirez
authors.forename: G M
authors.initials: GM
authors.lastname: Lew
authors.forename: R M
authors.initials: RM
authors.lastname: Genta
authors.forename: D Y
authors.initials: DY
authors.lastname: Graham
mesh_terms: D000328:Adult; D000368:Aged; D001729:Bismuth / Q000627:therapeutic use*; D017291:Clarithromycin / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000627:therapeutic use*; D010437:Peptic Ulcer / Q000188:drug therapy / Q000382:microbiology; D011899:Ranitidine / Q000627:therapeutic use; D012459:Salicylates / Q000627:therapeutic use*; D013752:Tetracycline / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D009942:Organometallic Compounds; D012459:Salicylates; C015715:bismuth subsalicylate; D011899:Ranitidine; D013752:Tetracycline; D017291:Clarithromycin; D001729:Bismuth