Triple Therapy with Ranitidine, Clarithromycin, and Metronidazole in the Treatment of Helicobacter pylori

Abstract

Background: To determine whether a triple therapy regimen for the treatment of Helicobacter pylori infection, consisting of ranitidine 300 mg q.i.d., clarithromycin 500 mg t.i.d., and metronidazole 500 mg t.i.d. would provide a safe and effective treatment regimen, we performed an open prospective study in 20 consecutive patients with proven H. pylori-associated non-ulcer dyspepsia or peptic ulcer disease. Methods: The percentage of patients in whom eradication of H. pylori succeeded was determined. A semiquantitative assessment of histology was performed, and the results were analysed using Wilcoxon's matched-pairs ranks tests; side effects were noted and graded. Results: Eradication was achieved in 19 of 20 patients, i.e. in 95% (confidence interval 85–100%). Eradication of the bacterium led to a significant improvement in semiquantitative histology scores; active antral inflammation decreased from (mean ± SEM) 1.84 ± 0.19 to 0.21 ± 0.16 (p = 0.0004) and chronic antral inflammation from 2.47 ± 0.14 to 1.16 ± 0.14 (p = 0.0002); active gastric body inflammation decreased from 0.95 ± 0.19 to 0.00 ± 0.00 (p = 0.0015) and chronic inflammation from 1.68 ± 0.17 to 0.32 ± 0.11 (p = 0.0007). Side effects occurred in 45% of patients, but in over half of these patients only mild side effects occurred. Severe side effects did not occur, none of the patients discontinued the triple therapy. Conclusions: Triple therapy with ranitidine, clarithromycin, and metronidazole provides a safe and effective treatment of H. pylori infection, resulting in a high eradication rate, and in significant decrease in semiquantitative histology scores. Further prospective studies are warranted.

Key Words:

• Clarithromycin
• eradication
• gastritis
• Helicobacter pylori
• ranitidine
• triple therapy