One-week ranitidine bismuth citrate, amoxicillin and metronidazole triple therapy for the treatment of Helicobacter pylori infection in Chinese

Aliment Pharmacol Ther. 2002 Dec;16(12):2067-72. doi: 10.1046/j.1365-2036.2002.01384.x.


Background: We have previously shown that ranitidine bismuth citrate-based, clarithromycin-containing triple therapy achieves a higher eradication rate than proton pump inhibitor-based regimens in areas with a high prevalence of metronidazole resistance.

Aim: To evaluate whether this higher efficacy of ranitidine bismuth citrate over proton pump inhibitor can be extended to non-clarithromycin-containing regimens.

Methods: Helicobacter pylori-positive dyspeptic patients were randomized to receive either ranitidine bismuth citrate, 400 mg, amoxicillin, 1000 mg, and metronidazole, 400 mg, or omeprazole, 20 mg, amoxicillin, 1000 mg, and metronidazole, 400 mg, each given twice daily for 1 week. H. pylori eradication was confirmed by 13C-urea breath test 5 weeks later. The side-effects of the treatments were documented.

Results: Two hundred and twenty-nine patients were eligible for analysis. By intention-to-treat and per protocol analysis, the eradication rates were 77% and 79%, respectively, in the ranitidine bismuth citrate-amoxicillin-metronidazole group and 77% and 82%, respectively, in the omeprazole-amoxicillin-metronidazole group (P = 0.58 and P = 0.65). However, patients in the omeprazole-amoxicillin-metronidazole group reported a significantly higher incidence of minor side-effects when compared to those in the ranitidine bismuth citrate-amoxicillin-metronidazole group (P = 0.001).

Conclusions: Ranitidine bismuth citrate-amoxicillin-metronidazole was equally as effective as omeprazole-amoxicillin-metronidazole triple therapy, and may be considered as an alternative non-clarithromycin-based regimen in the Chinese population.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Amoxicillin / therapeutic use
  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use*
  • Anti-Ulcer Agents / therapeutic use*
  • Bismuth / adverse effects
  • Bismuth / therapeutic use*
  • Drug Therapy, Combination
  • Duodenal Ulcer / drug therapy
  • Duodenal Ulcer / microbiology
  • Dyspepsia / drug therapy
  • Dyspepsia / microbiology
  • Female
  • Helicobacter Infections / drug therapy*
  • Helicobacter Infections / ethnology
  • Helicobacter pylori*
  • Humans
  • Male
  • Metronidazole / therapeutic use
  • Middle Aged
  • Penicillins / therapeutic use
  • Ranitidine / adverse effects
  • Ranitidine / analogs & derivatives*
  • Ranitidine / therapeutic use*
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Anti-Ulcer Agents
  • Penicillins
  • Metronidazole
  • ranitidine bismuth citrate
  • Amoxicillin
  • Ranitidine
  • Bismuth