title: The effect of Helicobacter pylori retreatment with ranitidine bismuth citrate, clarithromycin, and metronidazole depends on the first-line therapy.
abstract: BACKGROUND
  Helicobacter pylori eradication rates seem to decrease. This study evaluates the effect of retreatment with ranitidine bismuth citrate (RBC) 400 mg B.I.D., clarithromycin (C) 500 mg B.I.D., and metronidazole (M) 500 mg every morning and 1,000 mg every evening for 14 days [RBC.C.M].
  
  
  METHODS
  Nine gastroenterologic units included patients with unsuccessful eradication of H. pylori in a preceding randomized trial. Previous treatment was either omeprazole (O) 20 mg, C 250 mg, and M 500 mg [O.C.M] or RBC 400 mg, tetracycline (T) 1,000 mg, and M 500 mg [RBC x T x M]; all drugs were given twice daily for 7 days.
  
  
  RESULTS
  Twenty-six H. pylori-positive patients were included (nine males, 17 females; mean age, 54 years; range, 39-74 years). The eradication rates in the groups previously treated with O.C.M and RBC.T.M were three of nine (33%) (95% CI = 12-65) and 15 of 17 (88%) (95% CI = 66-97) respectively (p = 0.008). The corresponding results in a "per-protocol" analysis were three of eight (38%) (95% CI = 13-69) and 10 of 10 (100%) (95% CI = 72-100), respectively (p = 0.007). A side effect score was 21.8 compared with 8.3 in the previous study (p < 0.001).
  
  
  CONCLUSIONS
  The effect of a retreatment regimen depends on the preceding treatment. The RBC x C x M regimen is effective in nonresponders to RBC x T x M, but it seems unsuitable after failure of the O x C x M regimen.
authors.affiliation: Unit for Applied Clinical Research, Norweigian University of Science and Technology, Trondheim, Norway. per.farup@medisin.ntnu.no
authors.forename: Per G
authors.initials: PG
authors.lastname: Farup
authors.forename: Ove J
authors.initials: OJ
authors.lastname: Lange
authors.forename: Jan
authors.initials: J
authors.lastname: Tholfsen
authors.forename: Victor
authors.initials: V
authors.lastname: Høeg
authors.forename: Sigurd
authors.initials: S
authors.lastname: Wetterhus
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001729:Bismuth / Q000627:therapeutic use*; D017291:Clarithromycin / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D011899:Ranitidine / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D019233:Retreatment; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D008795:Metronidazole; C073340:ranitidine bismuth citrate; D011899:Ranitidine; D017291:Clarithromycin; D001729:Bismuth