Six-day therapy with ranitidine bismuth citrate plus low-dose clarithromycin and tinidazole to cure Helicobacter pylori infection

Background/Aims: Short-term ranitidine bismuth citrate-based triple regimens have been shown to be effective for the eradication of H.pylori. We investigated the efficacy of an eradicating therapy including ranitidine bismuth citrate, low-dose clarithromycin and tinidazole, administered for only 6 days. Methodology: Forty-five consecutive patients, who underwent gastroscopy for symptoms and were found to be H.pylori-positive, were recruited. They received ranitidine bismuth citrate 400mg b.i.d. plus clarithromycin 250mg b.i.d. plus tinidazole 500mg b.i.d., given for 6 days. The medications given in twice daily doses were taken after meals with an interval of 12 h. The H. pylori status was evaluated by means of histology and rapid urease test on admission, and by 13C-urea breath test alone 8 weeks after treatment. Results: All 45 enrolled patients completed the study. Thirty-nine of 45 patients returned H.pylori-negative (both per protocol and intention-to-treat analysis = 87%; 95% confidence interval = from 73-95%), while 6 of 45 were still H.pylori-positive (13%). Slight or mild side effects occurred in 5/45 patients (11%). Conclusions: Ranitidine bismuth citrate-based triple therapy, containing low-dose clarithromycin and tinidazole, given for only 6 days, yielded high eradication rates with modest side effects. Regimens based on ranitidine bismuth citrate plus two antibiotics at low dosages, administered for less than 7 days, constitute highly promising strategies for eradication of H.pylori.