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October 9, 1996

Practice Guidelines for Treatment of Peptic Ulcer Disease

Author Affiliations

Oregon Health Sciences University Portland

JAMA. 1996;276(14):1135. doi:10.1001/jama.1996.03540140023009

To the Editor.  —Dr Soll and colleagues1 acknowledge that treatment regimens for peptic ulcer disease remain cumbersome and recognize the need for more data from rigorous controlled trials; I am in total agreement. However, they follow this statement by mentioning that 3 regimens (a bismuth-based triple-therapy regimen, a proton pump inhibitor [PPI], and a PPI with 2 of these antibiotics: clarithromycin, metronidazole, or amoxicillin), out of the many described in the literature, are cautiously recommended. To my knowledge, there are no controlled prospective trials of US patients on which to base this recommendation. Furthermore, there are no community-based studies looking at the effectiveness of any single regimen.It is further stated that the combination of ranitidine bismuth subcitrate and clarithromycin, despite having received approval by the Food and Drug Administration (FDA), should not be used without the addition of tetracycline or amoxicillin. I am unaware of any such data suggesting