scholarly journals Bismuth-Based Quadruple Therapy with Bismuth Subcitrate, Metronidazole, Tetracycline and Omeprazole in the Eradication ofHelicobacter pylori

2001 ◽  
Vol 15 (9) ◽  
pp. 581-585 ◽  
Author(s):  
Raymond Lahaie ◽  
Alain Farley ◽  
Chrystian Dallaire ◽  
André Archambault ◽  
Carlo A Fallone ◽  
...  
Keyword(s):  
Eradication Rate ◽  
Previous Attempt ◽  
Colloidal Bismuth Subcitrate ◽  
Minimal Inhibitory Concentrations ◽  
Bismuth Subcitrate ◽  
Antiulcer Drugs ◽  
Resistant Strains ◽  
H Pylori ◽  
Irritable Bowel ◽  
Intent To Treat

BACKGROUND: A previous study showed that 14 days of qid bismuth-based triple therapy with tetracycline 500 mg, metronidazole 250 mg and colloidal bismuth subcitrate 120 mg resulted in excellentHelicobacter pylorieradication rates (89.5%). The present study looked at a shorter treatment period by adding omeprazole and by reducing the dose of tetracycline.METHODS: One hundred sixty-one patients withH pyloriconfirmed by histology and13carbon urea breath test were included in the study. They were treated for seven days with bismuth subcitrate 120 mg plus metronidazole 250 mg plus tetracycline 250 mg qid plus omeprazole 20 mg bid (OBMT). Patients were 18 to 75 years of age and had dyspepsia with or without a history of peptic ulcer. Patients with irritable bowel syndrome, active ulcer or previous attempt at eradication, or those who had used antibiotics or antiulcer drugs in the previous 30 days were excluded. Eradication was determined by two13carbon urea breath tests done one and three months, respectively, after treatment. Strains with minimal inhibitory concentrations of 8 µg/mL or higher were considered to be resistant to metronidazole.RESULTS: The overall per protocol eradication rate was 84% - 89.5% in metronidazole-sensitive and 70.8% in metronidazole-resistant strains. Modified intent-to-treat analysis resulted in a 80% eradication rate - 82.5% in metronidazole-sensitive and 66.7% in metronidazole-resistant strains. Only one patient discontinued treatment because of adverse events.CONCLUSIONS: The OBMT regimen used in this study is safe and effective against metronidazole-sensitiveH pyloristrains.

scholarly journals Bismuth-Based Triple Therapy with Bismuth Subcitrate, Metronidazole and Tetracycline in the Eradication ofHelicobacter pylori: A Randomised, Placebo Controlled, Double-Blind Study

2000 ◽  
Vol 14 (7) ◽  
pp. 599-602 ◽  
Author(s):  
Sander Veldhuyzen van Zanten ◽  
Alain Farley ◽  
Norman Marcon ◽  
Raymond Lahaie ◽  
André Archambault ◽  
...  
Keyword(s):  
Triple Therapy ◽  
Previous Attempt ◽  
Double Blind Study ◽  
Double Blind ◽  
Colloidal Bismuth Subcitrate ◽  
Intention To Treat ◽  
First Line Therapy ◽  
Bismuth Subcitrate ◽  
H Pylori ◽  
Colloidal Bismuth

OBJECTIVE: To determine the rate ofHelicobacter pylorieradication following bismuth-based triple therapy with colloidal bismuth subcitrate, tetracycline hydrochloride and metronidazole.PATIENTS AND METHODS: One hundred and eleven patients were randomly assigned, in a two to one ratio, to colloidal bismuth subcitrate 120 mg qid plus metronidazole 250 mg qid plus tetracycline 500 mg qid (Gastrostat), or matching placebo tablets and capsules for 14 days. Presence or absence ofH pyloriwas documented by histology at entry and at least 28 days after treatment. Patients had dyspeptic symptoms with or without a history of peptic ulcer. Patients with any previous attempt(s) at eradication ofH pylori, who used bismuth, antibiotics, H2 receptor antagonists or proton pump inhibitors in the previous four weeks were excluded.RESULTS: Fifty-three of 59 (90%) patients on bismuth-based treatment and only one of 35 (3%) on placebo achieved eradication by per protocol analysis. Fifty-three of 65 (82%) patients on bismuth-based treatment achieved eradication, while only two of 34 (5%) achieved eradication on placebo by intention to treat analysis. Eradication rates for bismuth-based treatment across sites ranged from 83% to 100%. Only two patients in the bismuth-based treatment group (4%) and one in the placebo group (3%) discontinued treatment because of adverse events.CONCLUSIONS: Colloidal bismuth subcitrate plus metronidazole plus tetracycline, given in the doses studied for 14 days, is safe and highly effective againstH pyloriinfection and would be appropriate as a first-line therapy for eradication.

scholarly journals The Action of Bismuth against Helicobacter pylori Mimics but Is Not Caused by Intracellular Iron Deprivation

2004 ◽  
Vol 48 (6) ◽  
pp. 1983-1988 ◽  
Author(s):  
Michael V. Bland ◽  
Salim Ismail ◽  
Jack A. Heinemann ◽  
Jacqueline I. Keenan
Keyword(s):  
Helicobacter Pylori ◽  
Antimicrobial Effect ◽  
Iron Limitation ◽  
Intracellular Iron ◽  
Colloidal Bismuth Subcitrate ◽  
Iron Deprivation ◽  
Atp Levels ◽  
Bismuth Subcitrate ◽  
Membrane Changes ◽  
H Pylori

ABSTRACT Helicobacter pylori is highly susceptible to bismuth, a heavy metal with antimicrobial activity linked to its effect on bacterial iron uptake. Three strains of H. pylori were analyzed for indicators of iron limitation following exposure to the MIC of colloidal bismuth subcitrate (MICCBS). Similar morphologic and outer membrane changes were observed following growth in iron-limiting medium and at the MICCBS that inhibited the growth of all three strains. These changes, which were also observed for iron-limited bacteria, were alleviated by the addition of iron to the cultures. H. pylori ATP levels, reduced in iron-limiting medium, were below the limits of detection in two of the three strains following exposure to bismuth. The addition of iron partially restored bacterial ATP levels in these two strains, although not to normal concentrations. In contrast, exposure of the same strains to the MICCBS failed to deplete intracellular levels of iron, which were significantly reduced by culturing in iron-limiting medium. Thus, the antimicrobial effect of bismuth and of iron limitation on H. pylori may be similar. However, the respective mechanisms of intracellular action would appear to be mediated by different pathways within the cell.

scholarly journals Rescue therapy with rifabutin regimen for refractory Helicobacter pylori infection with dual drug-resistant strain

2020 ◽  
Author(s):  
Chia-Jung Kuo ◽  
Cheng-Yu Lin ◽  
Puo-Hsien Le ◽  
Pi-Yueh Chang ◽  
Chih-Ho Lai ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Triple Therapy ◽  
Eradication Rate ◽  
Rescue Therapy ◽  
Univariate Analysis ◽  
Drug Resistant ◽  
Resistant Strains ◽  
H Pylori ◽  
Drug Resistant Strains ◽  
Dual Drug

Abstract Background: There is no current standard rescue treatment for dual drug-resistant strains of Helicobacter pylori. This aim of this study was to investigate the efficacy of rifabutin-based triple therapy for patients infected with dual drug-resistant strains to clarithromycin and levofloxacin.Methods: After two or three H. pylori treatment failures, patients underwent upper endoscopy with tissue biopsies. Phenotypic and genotypic resistance was determined using agar dilution test and polymerase chain reaction with direct sequencing, respectively. Patients infected with dual drug-resistant (clarithromycin and levofloxacin) strains and received rifabutin based triple therapy (rifabutin 150 mg bid, amoxicillin 1 g bid and esomeprazole 40 mg bid for 10 days) were enrolled. Eradication status was determined by 13C-urea breath test four weeks after treatment completion. Results: A total of 39 patients infected with dual drug-resistant strains were enrolled in this study, with a mean age of 55.9 years. The eradication rate was 79.5% (31/39). Adverse event was reported in 23.1% (9/39) of patients but mild and tolerable. In univariate analysis, no factor was identified as an independent predictor of eradication failure. Conclusions: Our current study demonstrated that rifabutin-based triple therapy was well tolerated and yielded an acceptable eradication rate for patients infected with dual drug-resistant strains of H. pylori.

scholarly journals Survey of anaemia andHelicobacter pyloriinfection in adolescent girls in Suihua, China and enhancement of iron intervention effects byH. pylorieradication

2011 ◽  
Vol 108 (2) ◽  
pp. 357-362 ◽  
Author(s):  
Wei Xia ◽  
Xin Zhang ◽  
Jiajia Wang ◽  
Caihong Sun ◽  
Lijie Wu
Keyword(s):  
Adolescent Girls ◽  
Intervention Group ◽  
Fe Deficiency ◽  
Control Group ◽  
Colloidal Bismuth Subcitrate ◽  
Bismuth Subcitrate ◽  
H Pylori ◽  
And Control ◽  
The Relationship ◽  
Colloidal Bismuth

In the present study, we investigated the prevalence of anaemia and Fe deficiency anaemia (IDA) and explored the relationship betweenHelicobacter pyloriinfection and IDA in adolescent girls. A total of 1037 adolescent girls from Suihua, China were enrolled. Hb, serum ferritin (SF), serum transferrin receptor (sTfR) and serum IgG antibodies toH. pyloriwere measured. Participants with IDA and co-existingH. pyloriinfection (n80) who had an intake of >25 mg/d of Fe were assigned randomly to the intervention and control groups. Patients in the intervention group were administered a 12-week course of oral EDTA–Na–Fe (60 mg Fe/dose, three times a week) and a 2-week course of colloidal bismuth subcitrate, amoxicillin and metronidazole. Subjects in the control group were administered EDTA–Na–Fe alone. Hb, SF and sTfR were reassessed 3 months after the 12-week regimen ended. Prevalence of anaemia, Fe deficiency (defined as SF < 12·0 μg/l), IDA andH. pyloriinfection in the population of 1037 was 19·5, 40·4, 17·1 and 31·2 %, respectively. The prevalence ofH. pyloriinfection in the IDA group was 46·9 %, while the non-anaemic group had 28·1 % prevalence. A significant increase in Hb and SF and a decrease in sTfR value were found in the intervention group and theH. pylori-negative group. Findings suggest that IDA is still one of the prominent problems in adolescent girls. There is an association betweenH. pyloriinfection and IDA. Treatment ofH. pyloriinfection is associated with a more rapid response to oral Fe therapy.

scholarly journals Efficacy and Safety of Wei Bi Mei, a Chinese Herb Compound, as an Alternative to Bismuth for Eradication of Helicobacter pylori

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Lei Li ◽  
FanDong Meng ◽  
Shengtao Zhu ◽  
ShuiLong Guo ◽  
YongJun Wang ◽  
...  
Keyword(s):  
Chinese Herb ◽  
Efficacy And Safety ◽  
Sprague Dawley ◽  
Chinese Medicinal Herb ◽  
Colloidal Bismuth Subcitrate ◽  
Synthetic Drugs ◽  
Bismuth Compounds ◽  
Bismuth Subcitrate ◽  
Metronidazole Resistance ◽  
H Pylori

Bismuth-containing quadruple therapy has been recommended as the first line of treatment in areas of high clarithromycin or metronidazole resistance. However, safety concerns of bismuth agents have long been raised. We first assessed the efficacy and safety of Wei Bi Mei granules, which are bismuth compounds consisting of three synthetic drugs and five medicinal herbs, compared to bismuth aluminate and colloidal bismuth subcitrate (CBS) in H. pylori-infected mouse model. We then used atomic fluorescence spectroscopy and autometallography to measure the accumulation of three bismuth agents in the brain, heart, liver, and kidneys in adult Sprague-Dawley rats. We also evaluated the safety of bismuth agents by conducting clinical biochemistry tests in blood samples of experimental animals. Wei Bi Mei granules exhibited the highest efficacy of anti-H. pylori activity and yielded the lowest bismuth accumulation when compared to CBS and bismuth aluminate. Our findings show that Wei Bi Mei granules are a safe Chinese medicinal herb with potent anti-H. pylori activity and can be considered as an alternative to current bismuth compounds. Thus, Wei Bi Mei granules merit further evaluation, particularly with regard to efficacy and safety when they are combined with other H. pylori eradication medications in the clinical setting.

scholarly journals Antibiotic Susceptibilities ofHelicobacter pyloriStrains Isolated in the Province of Alberta

1998 ◽  
Vol 12 (4) ◽  
pp. 295-298 ◽  
Author(s):  
Diane E Taylor ◽  
Qin Jiang ◽  
Richard N Fedorak
Keyword(s):  
Helicobacter Pylori ◽  
Antibiotic Resistance ◽  
Gastric Biopsy ◽  
Minimal Inhibitory Concentrations ◽  
Antibiotic Susceptibilities ◽  
Biopsy Specimens ◽  
Metronidazole Resistance ◽  
Agar Dilution ◽  
Resistant Strains ◽  
H Pylori

The incidence of antibiotic resistance to amoxicillin, clarithromycin, erythromycin, metronidazole and tetracycline inHelicobacter pyloristrains isolated from gastric biopsy specimens obtained in Alberta was investigated. Results for all antibiotics were obtained using agar dilution, and in addition to metronidazole, the E test was used. Resistance to amoxicillin and tetracycline was not detected. Metronidazole resistance determined using agar dilution was approximately 12% (95% CI 4% to 26%) when minimal inhibitory concentrations (MICs) were at least 8 µg/mL, but fell to 2% (95% CI 0.1% to 13%) when MICs were set at 32 µg/mL or greater. The E test for metronidazole resistance (MIC 8 µg/mL or greater) yielded a slightly higher percentage of resistant strains compared with agar dilution tests (14%, 95% CI 5% to 29%). One of the 31 strains was resistant to clarithromycin (MIC 8 µg/mL) and erythromycin (MIC 16 µg/mL). Thus, the incidence of resistance to clarithromycin, part of the currently used triple therapy for eradication ofH pylori, was 3% (95% CI 0.1% to 17%).

Bismuth salts and neurotoxicity. A randomised, single-blind and controlled study

1995 ◽  
Vol 14 (4) ◽  
pp. 349-355 ◽  
Author(s):  
LA Noach ◽  
Jla Eekhof ◽  
LJ Bour ◽  
FE Posthumus Meyjes ◽  
Gnj Tytgat ◽  
...  
Keyword(s):  
Controlled Study ◽  
Control Group ◽  
Colloidal Bismuth Subcitrate ◽  
Bismuth Subcitrate ◽  
Before And After ◽  
Bismuth Salts ◽  
Bismuth Subnitrate ◽  
Eeg Recordings ◽  
H Pylori ◽  
Single Blind

The aim of this work was to investigate whether the nor mal use of colloidal bismuth subcitrate (CBS) and bismuth subnitrate (BSN) exhibits neurotoxic side-effects. A ran domised, single-blind controlled study was carried out in 66 patients with H. pylori associated gastritis. Patients were randomised to receive either amoxicillin (control group) for 4 weeks or BSN for 8 weeks or CBS for 8 weeks. Clinical and neurophysiological tests including elec troneurography (ENG) and spectral electroencephalogra phy (EEG) were performed before and after therapy. No clinically relevant changes were observed with clinical tests as well as with ENG and spectral EEG recordings within each group and between the groups. It was con cluded that the normal use of CBS and BSN does not exhibit clinical neurotoxicity.

scholarly journals Influence of metronidazole resistance on efficacy of quadruple therapy for Helicobacter pylori eradication

Gut ◽  
1998 ◽  
Vol 42 (2) ◽  
pp. 166-169 ◽  
Author(s):  
R W M van der Hulst ◽  
A van der Ende ◽  
A Homan ◽  
P Roorda ◽  
J Dankert ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Triple Therapy ◽  
Quadruple Therapy ◽  
Colloidal Bismuth Subcitrate ◽  
Intention To Treat ◽  
Group I ◽  
Bismuth Subcitrate ◽  
Metronidazole Resistance ◽  
Group Ii ◽  
H Pylori

Background—Metronidazole-containing eradication therapies are less effective for metronidazole resistantHelicobacter pylori. Although early data suggested improvement of the efficacy of bismuth triple therapy after the addition of acid suppressives, these findings were based on studies with small numbers of patients, incomplete post-eradication follow up, or omission of pretreatment susceptibility testing.Aims—To study the efficacy of quadruple therapy in the Amsterdam area, where the efficacy of bismuth triple therapy has been proved to be affected by metronidazole resistance.Patients and methods—Eighty two consecutive dyspeptic H pylori positive patients with either metronidazole susceptible (group I) or metronidazole resistant H pylori strains (group II) received quadruple therapy for one week: omeprazole 20 mg twice daily; colloidal bismuth subcitrate 120 mg four times a day; tetracycline 500 mg four times a day; metronidazole 500 mg three times a day. Susceptibility to metronidazole was determined by the E-test.Results—Intention to treat analysis showed thatH pylori infection had been cured in 42/43 patients (98%) in group I and 32/39 patients (82%) in group II (p = 0.02).Conclusion—The efficacy of quadruple therapy is significantly impaired in patients infected with metronidazole resistant H pylori. Therefore a non-metronidazole-containing regimen should preferably be used in areas known to have a high prevalence of pretreatment metronidazole resistance.

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