title: One-week ranitidine bismuth citrate-based triple therapy for the eradication of Helicobacter pylori in Hong Kong with high prevalence of metronidazole resistance.
abstract: OBJECTIVE
  To compare 1-week ranitidine bismuth citrate-based (RBC) triple therapy vs. omeprazole-based (O) triple therapy for the eradication of Helicobacter pylori infection in Hong Kong with high prevalence of metronidazole resistance.
  
  
  METHODS
  Patients with non-ulcer dyspepsia and H. pylori infection were randomized to receive either: (i) RBCCM: ranitidine bismuth citrate (pylorid) 400 mg, clarithromycin 250 mg and metronidazole 400 mg; or (ii) OCM: omeprazole 20 mg, clarithromycin 250 mg and metronidazole 400 mg, each given twice daily for 1 week. Endoscopy (CLO test, histology and culture) and 13C-urea breath test were performed before randomization and 6 weeks after drug treatment.
  
  
  RESULTS
  A total of 180 patients were randomized. H. pylori eradication rates (intention-to-treat, n=180/per protocol, n=166) were 83%/92% for RBCCM and 66%/70% for OCM (P=0.01, intention-to-treat and P=0.001, per protocol, respectively). RBCCM treatment was unaffected by metronidazole susceptibility and achieved a significantly higher eradication rate in metronidazole-resistant cases (89%) than the OCM group (45%, P=0.0064).
  
  
  CONCLUSIONS
  One-week ranitidine bismuth citrate-based triple therapy is significantly better than omeprazole-based triple therapy for the eradication of H. pylori infection, especially in metronidazole-resistant cases. It is an effective regimen for the eradication of H. pylori infection in regions with a high prevalence of metronidazole resistance.
authors.affiliation: Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong. bcywong@hku.hk
authors.forename: B C
authors.initials: BC
authors.lastname: Wong
authors.forename: W M
authors.initials: WM
authors.lastname: Wong
authors.forename: W H
authors.initials: WH
authors.lastname: Wang
authors.forename: F M
authors.initials: FM
authors.lastname: Fung
authors.forename: K C
authors.initials: KC
authors.lastname: Lai
authors.forename: K M
authors.initials: KM
authors.lastname: Chu
authors.forename: S T
authors.initials: ST
authors.lastname: Yuen
authors.forename: S Y
authors.initials: SY
authors.lastname: Leung
authors.forename: W H
authors.initials: WH
authors.lastname: Hu
authors.forename: M F
authors.initials: MF
authors.lastname: Yuen
authors.forename: G K
authors.initials: GK
authors.lastname: Lau
authors.forename: C K
authors.initials: CK
authors.lastname: Chan
authors.forename: S K
authors.initials: SK
authors.lastname: Lam
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000494:pharmacology / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001729:Bismuth; D001944:Breath Tests; D002247:Carbon Isotopes; D017291:Clarithromycin / Q000494:pharmacology / Q000627:therapeutic use*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000473:pathology; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000494:pharmacology / Q000627:therapeutic use*; D008875:Middle Aged; D009853:Omeprazole / Q000494:pharmacology / Q000627:therapeutic use*; D015995:Prevalence; D011899:Ranitidine / Q000031:analogs & derivatives; D016896:Treatment Outcome; D014508:Urea / Q000032:analysis
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D000897:Anti-Ulcer Agents; D002247:Carbon Isotopes; D008795:Metronidazole; C073340:ranitidine bismuth citrate; D011899:Ranitidine; D014508:Urea; D017291:Clarithromycin; D009853:Omeprazole; D001729:Bismuth