Vondracek T G
College of Pharmacy, University of Oklahoma, Oklahoma City 73190, USA.
Ann Pharmacother. 1998 Jun;32(6):672-9. doi: 10.1345/aph.17247.
To review the clinical pharmacology of ranitidine bismuth citrate in the treatment of Helicobacter pylori (HP) infection and duodenal ulcer.
A MEDLINE search of the English-language literature from 1992 to January 1997 was conducting using the key terms Tritec, ranitidine, and bismuth. References of articles pertaining to treatment of duodenal ulcer or HP were extensively searched for relevant sources.
All articles pertaining to ranitidine bismuth citrate were considered for inclusion, with emphasis placed on randomized, double-blind trials. Priority was placed on data pertaining to regimens that are currently approved by the Food and Drug Administration for the treatment of duodenal ulcer in conjunction with HP.
Each tablet of ranitidine bismuth citrate 400 mg contains 162 mg of ranitidine base, 128 mg of trivalent bismuth, and 110 mg of citrate. It uses the acid-suppressive actions of ranitidine and the antimicrobial and mucosal protective effects of bismuth to eradicate HP. Ranitidine bismuth citrate in conjunction with clarithromycin represents one of four treatment regimens currently approved in the US for duodenal ulcer associated with HP infection. In four double-blind, randomized trials, this agent has achieved HP eradication rates of 73-94% and duodenal ulcer healing rates of 73-89%. It is given twice daily for 28 days, and is associated with very low rates of adverse effects.
Relative to some therapeutic alternatives, ranitidine bismuth citrate plus clarithromycin may be simpler to take and have less adverse effects, but may be more expensive. Compared with omeprazole plus clarithromycin, it is less expensive, may have lower ulcer healing rates, but may be more effective in eradicating HP. The role of ranitidine bismuth citrate will continue to evolve as more patients are treated, and other regimens continue to be tested for duodenal ulcer healing and HP eradication.
综述枸橼酸铋雷尼替丁治疗幽门螺杆菌（HP）感染及十二指肠溃疡的临床药理学。
1992年至1997年1月期间，使用关键词“得乐”、“雷尼替丁”和“铋”在MEDLINE数据库中检索英文文献。广泛检索与十二指肠溃疡或HP治疗相关文章的参考文献，以寻找相关资料。
纳入所有与枸橼酸铋雷尼替丁相关的文章，重点关注随机、双盲试验。优先选取与目前美国食品药品管理局批准的用于治疗合并HP感染的十二指肠溃疡方案相关的数据。
每片400mg枸橼酸铋雷尼替丁含162mg雷尼替丁碱、128mg三价铋和110mg枸橼酸盐。它利用雷尼替丁的抑酸作用以及铋的抗菌和黏膜保护作用来根除HP。枸橼酸铋雷尼替丁联合克拉霉素是目前美国批准的用于治疗与HP感染相关的十二指肠溃疡的四种治疗方案之一。在四项双盲、随机试验中，该药物的HP根除率达73% - 94%，十二指肠溃疡愈合率达73% - 89%。每日服用两次，共28天，不良反应发生率极低。
相对于某些治疗选择，枸橼酸铋雷尼替丁加克拉霉素服用可能更简便，不良反应更少，但可能更昂贵。与奥美拉唑加克拉霉素相比，它价格较低，溃疡愈合率可能较低，但在根除HP方面可能更有效。随着更多患者接受治疗，以及其他方案继续接受十二指肠溃疡愈合和HP根除的试验，枸橼酸铋雷尼替丁的作用将不断演变。
