Ranitidine, A Potential Option for Helicobacter pylori Eradication


Abstract views: 42 / PDF downloads: 32

Authors

DOI:

https://doi.org/10.5152/EurJTher.2019.18068

Abstract

I have read with great interest the study reported by Şahin and Yılmaz (1), which described the case of a 15-year-old male patient diagnosed with Helicobacter pylori (H. pylori) infection and allergy to both all proton pump inhibitors (PPIs) and famotidine. The bacterial infection was eradicated using a quadruple treatment comprising ranitidine, bismuth, metronidazole and tetracycline. This case provides us with an important message for clinical practice.Because a profound acid suppression is required to eradicate H. pylori infection, the Maastricht V/Florence Consensus Report recommends using a combination of a PPI and two or three antibiotics to eradicate H. pylori infection (2).Several studies demonstrated a remarkable reduction in the activity of the main antibiotics used against H. pylori after reducing the pH from 8 to 5. This is because concentration of these drugs in the mucosa, a key factor for H. pylori eradication, decreases concomitantly with pH reduction (3). As PPIs are membrane permeable weak bases that accumulate in acid spaces of the active parietal cell, they share the same pharmacodynamics. Conventional PPIs are prodrugs that are activated by acids and covalently bind to their target, the H+/K+-ATPase (or proton pump) (4). Histamine represents the most important stimulus of the gastric parietal cells. Because this stimulatory action is mediated by the H2 subtype receptors, selective H2 receptor antagonists (such as ranitidine) are inhibitors of acid secretion. Despite the preference for PPIs, the use of ranitidine at high dosage (300 mg twice daily) permitted similar eradication rates (3).Furthermore, several studies reported that ranitidine can be safely co-administered with other drugs (4).To confirm the efficacy of ranitidine, in a previous study we showed that a ranitidine-based eradication treatment was not inferior to a similar PPI-based regimen (p=0.9) (5). In conclusion, in a setting where PPIs are not available or cannot be prescribed, ranitidine is an appropriate drug in a combined regimen for H. pylori eradication. It is probable that the availability of vonoprazan, a potassium-competitive acid blocker, as a new type of effective acid suppressant will offer new options in this field (4).

Metrics

Metrics Loading ...

References

Şahin Y, Yılmaz Ö. How should Helicobacter pylori eradication be done in the extensive proton pump inhibitor allergy? Eur J Ther 2019; 25: 89-92.

Malfertheiner P, Megraud F, O’Morain CA, Gisbert JP, Kuipers EJ, Axon AT, et al. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut 2017; 66: 6-30.

Klotz U. Pharmacokinetic considerations in the eradication of Helicobacter pylori. Clin Pharmacokinet 2000; 38: 243-70.

Pellicano R, Zagari RM, Zhang S, Saracco GM, Moss SF. Pharmacological considerations and step-by-step proposal for the treatment of Helicobacter pylori infection in the year 2018. Minerva Gastroenterol Dietol 2018; 64: 310-21.

Cisarò F, Astegiano M, De Angelis C, et al. Ranitidine bismuth citrate in the first-line of Helicobacter pylori treatment. Panminerva Med 2011; 53: 138.

Downloads

Published

2023-04-11

How to Cite

Pellicano, R. (2023). Ranitidine, A Potential Option for Helicobacter pylori Eradication. European Journal of Therapeutics, 25(2), 153–154. https://doi.org/10.5152/EurJTher.2019.18068

Issue

Section

Letter to the Editor