The efficacy of two-week therapy with ranitidine bismuth citrate, amoxicillin and clarithromycin on Helicobacter pylori eradication in clarithromycinresistant and- sensitive cases.
OBJECTIVE
Recent studies in Turkey have documented the noticeably low success rates of H. pylori eradication. It has become more important to identify the highly successful therapy regimens since clarithromycin resistance, one of the most important factors affecting the success rate of eradication therapies, continues to increase. The aim of this study was to assess the efficacy of two-week therapy with ranitidine bismuth citrate (RBC), amoxicillin (A), and clarithromycin (C) on H. pylori eradication, and the role of C resistance in eradication.


METHODS
The study included 45 dyspeptic patients with H. pylori diagnosed by urease test and histopathological examination. C resistance was studied by real-time PCR method on antral biopsy specimens. All patients were treated with a two-week therapy consisting of RBC: 2x400 mg, A: 2x1000 mg, and C: 2x500 mg, daily. Endoscopy was repeated at least one month after the end of the treatment. Presence of H. pylori was investigated by urease test and histopathological examination on antrum and corpus biopsies. Eradication was considered when both tests were negative for H. pylori in all specimens.


RESULTS
Two cases were lost to follow-up. The average age of the remaining 43 patients (22 males, 21 females) was 46.3+/-11.5 years. Mild side effects were encountered in 20 (46.5%) patients. Eradication was achieved in 35 (81.4%) patients. C resistance was studied in 26 patients and was detected in 10 (38.5%) of them. H. pylori eradication rate was 81.3% in C-sensitive (13/16) and 80% in C-resistant patients (8/10) (p>0.05).


CONCLUSIONS
A two-week regimen of RBC-A-C is very effective for H. pylori eradication even in C-resistant patients. These results suggest that RBC-A-C combination should be preferred for H. pylori eradication in Turkey.
Department of Gastroenterology, School of Medicine, Ege University, Izmir, Turkey. aaydin@med.ege.edu.tr
Ahmet
A
Aydin
Göktuğ F
GF
Onder
Ulus S
US
Akarca
Fatih
F
Tekin
Müge
M
Tunçyürek
Ahmet
A
Musoğlu
D000658:Amoxicillin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001729:Bismuth / Q000627:therapeutic use*; D017291:Clarithromycin / Q000627:therapeutic use*; D004269:DNA, Bacterial / Q000032:analysis; D024881:Drug Resistance, Bacterial; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000382:microbiology / Q000473:pathology; D005756:Gastritis / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011899:Ranitidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D004269:DNA, Bacterial; C073340:ranitidine bismuth citrate; D000658:Amoxicillin; D011899:Ranitidine; D017291:Clarithromycin; D001729:Bismuth