Salvage therapies after failure of Helicobacter pylori eradication with ranitidine bismuth citrate-based therapies

Aliment Pharmacol Ther. 2000 Jan;14(1):91-5. doi: 10.1046/j.1365-2036.2000.00674.x.


Background: Salvage therapies after initial Helicobacter pylori eradication failure of ranitidine bismuth citrate (RBC)-based regimens remain undefined.

Aim: To test the efficacy of 1-week omeprazole, amoxycillin and clarithromycin as a second-line treatment and 1-week quadruple therapy after repeated failures of RBC- and proton pump inhibitor-based regimens.

Method: Patients were recruited from a recently published prospective randomized study if confirmed to have failed H. pylori eradication with RBC-based regimens. They were given omeprazole 20 mg, amoxycillin 1 g and clarithromycin 500 mg (OAC) b.d. for 1 week. 13C-urea breath test was performed 4 weeks after the conclusion of medication. Those who failed to respond to OAC were given 1-week quadruple therapy (bismuth subcitrate 120 mg, tetracycline 500 mg and metronidazole 400 mg q.d.s. plus omeprazole 20 mg b.d.).

Results: Among 398 patients receiving RBC-based therapies, 40 (10%) had failed eradication (RAC=7, RC-2=12, RMC=7, and RMT=14). OAC was prescribed to 31 patients (RAC=4, RC-2=9, RMC=6, and RMT=12) and 68% had successful eradication. Nine out of 10 patients with failed second treatment received quadruple therapy; successful eradication occurred in 83% (5 out of 6) after repeated failures of clarithromycin-based regimens.

Conclusion: One-week OAC is not an optimal second-line therapy when RBC-clarithromycin combinations fail. Quadruple therapy appears to be effective despite repeated failures of clarithromycin-based RBC or proton pump inhibitor therapies.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Amoxicillin / therapeutic use
  • Anti-Bacterial Agents / therapeutic use
  • Anti-Ulcer Agents / therapeutic use*
  • Bismuth / therapeutic use*
  • Clarithromycin / therapeutic use
  • Enzyme Inhibitors / therapeutic use
  • Helicobacter Infections / drug therapy*
  • Helicobacter Infections / microbiology
  • Helicobacter pylori*
  • Humans
  • Omeprazole / therapeutic use
  • Penicillins / therapeutic use
  • Prospective Studies
  • Proton Pump Inhibitors
  • Ranitidine / analogs & derivatives*
  • Ranitidine / therapeutic use
  • Salvage Therapy*


  • Anti-Bacterial Agents
  • Anti-Ulcer Agents
  • Enzyme Inhibitors
  • Penicillins
  • Proton Pump Inhibitors
  • ranitidine bismuth citrate
  • Amoxicillin
  • Ranitidine
  • Clarithromycin
  • Omeprazole
  • Bismuth