Bismuth-based therapies for the first step eradication of Helicobacter pylori.
OBJECTIVE
Combination of a proton pump inhibitor, amoxicillin, and clarithromycin, which have been recommended as a primary treatment for Helicobacter pylori (H. pylori) infection, provides eradication in approximately 50% of cases of H. pylori infection in Turkey. There is no effective eradication regimen for H. pylori in our country. We aimed to compare bismuth- based triple and quadruple treatments for eradication of H. pylori.


METHODS
Eighty-two patients were enrolled into the study between October 2002 and August 2003. The patients were randomly assigned into two groups. One group received ranitidine bismuth citrate 2x400 mg, metronidazole 3x500 mg and tetracycline 2x1000 mg for 14 days (RMT group) and the other group pantoprazole 2x40 mg, bismuth subcitrate 4x300mg, amoxicillin 2x1000 mg and clarithromycin 2x500 mg for 14 days (PBAC group). The eradication was assessed four weeks after completion of the treatment, and the patients underwent endoscopy and were asked whether there were changes in their symptoms. When H. pylori was negative on both histological examination and urease test, the disease was considered eradicated.


RESULTS
H. pylori was eradicated in 26 of 42 patients in the RMT group (61.9%) and in 22 of 40 patients in the PBAC group (55%). In total, eradication was achieved in 48 out of 82 patients (58.5%). There was no significant difference in eradication between the groups.


CONCLUSIONS
Neither regimen (RMT or PBAC) was effective in eradicating H. pylori infection in our area. Further investigations are needed.
Sezgin
Orhan
O
Department of Gastroenterology, Mersin University, School of Medicine, Mersin, Turkey. sezginorhan@ttnet.net.tr
Altintaş
Engin
E
Uçbilek
Enver
E
Tataroğlu
Canten
C
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use; D000863:Antacids / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001729:Bismuth / Q000627:therapeutic use*; D001944:Breath Tests; D017291:Clarithromycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004415:Dyspepsia / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000378:metabolism*; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D000077402:Pantoprazole; D011899:Ranitidine / Q000627:therapeutic use; D013752:Tetracycline / Q000627:therapeutic use; D016896:Treatment Outcome; D014510:Urease / Q000378:metabolism; D055815:Young Adult
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000863:Antacids; D000890:Anti-Infective Agents; D000897:Anti-Ulcer Agents; D008795:Metronidazole; D000658:Amoxicillin; D011899:Ranitidine; D000077402:Pantoprazole; D014510:Urease; D013752:Tetracycline; D017291:Clarithromycin; D001729:Bismuth