Seven-day treatment for Helicobacter pylori infection: ranitidine bismuth citrate plus clarithromycin and tetracycline hydrochloride

Background: Dual therapy with ranitidine bismuth citrate plus clarithromycin twice daily for 14 days is an effective regimen for eradicating Helicobacter pylori infection. Aim: To determine whether this regimen can be improved by the addition of a second antibiotic, tetracycline hydrochloride, whilst reducing the duration of treatment to 7 days. Methods: Sixty-one out-patients were enrolled to this open treatment study, All had H. pylori infection, as determined by C-13-urea breath test and, for those undergoing endoscopy, by rapid urease test. Patients were treated with ranitidine bismuth citrate 400 mg, clarithromycin 500 mg and tetracycline hydrochloride 500 mg all twice daily for 7 days. Eradication of H. pylori was assessed by two separate C-13-urea breath tests, the first 28-68 days after the completion of treatment, the second 28-162 days later, a pylori infection was considered cured if both tests were negative. Results: All 61 patients were included in the intention-to-treat efficacy analysis. Successful eradication of H. pylori was achieved in 55/61 patients (90%; 95% CI: 82-98%). Fifty-nine out of sixty-one patients reported 100% compliance; one patient missed a single dose of medication and the other withdrew at 48 h due to nausea and vomiting. Minor adverse events were reported by 30/61 patients. Conclusion: One-week triple therapy with ranitidine bismuth citrate, clarithromycin and tetracycline, all twice daily, is a safe and well-tolerated regimen which eradicates H. pylori in 90% of infected patients.