title: Head-to-head comparison of 1-week triple regimens combining ranitidine or omeprazole with two antibiotics to eradicate Helicobacter pylori.
abstract: BACKGROUND
  Triple therapies containing omeprazole and ranitidine have been shown to be equivalent in eradicating H. pylori infection, but have been assessed either separately or head-to-head, only in small trials.
  
  
  OBJECTIVE
  To carry out a large randomized controlled study comparing omeprazole and ranitidine combined with two antibiotic combinations for 1 week.
  
  
  METHODS
  Three hundred and twenty H. pylori-positive patients were randomly subdivided into four equal-sized groups and received one of the following treatments: OAM = omeprazole 20 mg b.d. + amoxycillin 1 g b.d. + metronidazole 500 mg b.d.; RAM = ranitidine 300 mg b.d. + amoxycillin 1 g b.d. + metronidazole 500 mg b.d.; OAC = omeprazole 20 mg b.d. + amoxycillin 1 g b.d. + clarithromycin 250 mg t.d.s.; RAC = ranitidine 300 mg b.d. + amoxycillin 1 g b.d. + clarithromycin 250 mg t.d.s. The assessment of H. pylori status was performed before and 4 weeks after the end of therapy by means of CLO-test and histology. H. pylori infection was considered to be eradicated when both tests were negative.
  
  
  RESULTS
  OAM and RAM eradicated H. pylori in 89% and 85% of cases on per protocol (P = 0.48) and in 77% and 75% of cases on intention-to-treat analyses (P = 0.71). OAC and RAC eradicated H. pylori in 67% and 70% of cases on per protocol (P = 0.68) and in 57% and 64% of cases on intention-to-treat analyses (P = 0.41). In contrast, there was significant difference between OAM and OAC (P<0.01) and between RAM and RAC (P<0.05). Side-effects occurred in 15%, 10%, 17% and 16% of patients with respect to the above four subgroups.
  
  
  CONCLUSIONS
  Omeprazole and ranitidine combined with two antibiotics for 1 week are equally effective in the eradication of H. pylori infection, and these results question the role of profound acid suppression in the eradication of the bacterium.
authors.affiliation: Dipartimento di Medicina Interna, Cattedra di Gastroenterologia, Università di Genova, Italy. VSAVARIN@unige.it
authors.forename: V
authors.initials: V
authors.lastname: Savarino
authors.forename: P
authors.initials: P
authors.lastname: Zentilin
authors.forename: G
authors.initials: G
authors.lastname: Bisso
authors.forename: M
authors.initials: M
authors.lastname: Pivari
authors.forename: M R
authors.initials: MR
authors.lastname: Mele
authors.forename: G S
authors.initials: GS
authors.lastname: Mela
authors.forename: C
authors.initials: C
authors.lastname: Mansi
authors.forename: S
authors.initials: S
authors.lastname: Vigneri
authors.forename: R
authors.initials: R
authors.lastname: Termini
authors.forename: G
authors.initials: G
authors.lastname: Celle
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage*; D011899:Ranitidine / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D011899:Ranitidine; D009853:Omeprazole