Skip to main content
NCBI home page
Gut logoLink to Gut
. 1990 Sep;31(9):999–1002. doi: 10.1136/gut.31.9.999

Adjuvant antibiotic therapy in duodenal ulcers treated with colloidal bismuth subcitrate.

T O'Riordan 1, E Mathai 1, E Tobin 1, D McKenna 1, C Keane 1, E Sweeney 1, C O'Morain 1
PMCID: PMC1378656  PMID: 2210469

Abstract

Persistence of Helicobacter pylori after duodenal ulcer healing is associated with high rates of ulcer relapse. We compared colloidal bismuth subcitrate alone with CBS combined with one of four antibiotic regimens in the treatment of duodenal ulcers. Endoscopy and antral biopsies were performed before treatment and four weeks afterwards. Biopsy specimens were examined for histological evidence of gastritis and by Gram stain and culture for H pylori infection. Altogether 141 patients were allocated to one of five treatment groups. Giving CBS and metronidazole (400 mg tid for 7 days) with and without amoxycillin (500 mg tid) achieved higher clearance rates of H pylori than treatment with CBS alone (p less than 0.01). These two combinations also achieved higher rates of antral gastritis healing than CBS alone (p less than 0.01 and p less than 0.05 respectively). Susceptibility to metronidazole was tested in 29 isolates before and in seven isolates after treatment with metronidazole by disc diffusion test and minimum inhibitory concentration assay. Twenty seven (93%) of the isolates were sensitive before treatment while six of seven (86%) were resistant afterwards. Four of the six resistant strains had acquired resistance during treatment and one of these had acquired metronidazole resistance despite concomitant treatment with amoxycillin, to which it remained sensitive. CBS with adjuvant metronidazole at a dose of 400 mg tid for seven days significantly improves the eradication of H pylori compared with CBS alone. Acquired metronidazole resistance, however, seems to be an important cause of failure to eradicate H pylori.

Full text

PDF
999

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bayerdörffer E., Simon T., Bästlein C., Ottenjann R., Kasper G. Bismuth/ofloxacin combination for duodenal ulcer. Lancet. 1987 Dec 19;2(8573):1467–1468. doi: 10.1016/s0140-6736(87)91169-x. [DOI] [PubMed] [Google Scholar]
  2. Coghlan J. G., Gilligan D., Humphries H., McKenna D., Dooley C., Sweeney E., Keane C., O'Morain C. Campylobacter pylori and recurrence of duodenal ulcers--a 12-month follow-up study. Lancet. 1987 Nov 14;2(8568):1109–1111. doi: 10.1016/s0140-6736(87)91545-5. [DOI] [PubMed] [Google Scholar]
  3. Dooley C. P., Cohen H. The clinical significance of Campylobacter pylori. Ann Intern Med. 1988 Jan;108(1):70–79. doi: 10.7326/0003-4819-108-1-70. [DOI] [PubMed] [Google Scholar]
  4. Goodwin C. S. Duodenal ulcer, Campylobacter pylori, and the "leaking roof" concept. Lancet. 1988 Dec 24;2(8626-8627):1467–1469. doi: 10.1016/s0140-6736(88)90942-7. [DOI] [PubMed] [Google Scholar]
  5. Goodwin C. S., Marshall B. J., Blincow E. D., Wilson D. H., Blackbourn S., Phillips M. Prevention of nitroimidazole resistance in Campylobacter pylori by coadministration of colloidal bismuth subcitrate: clinical and in vitro studies. J Clin Pathol. 1988 Feb;41(2):207–210. doi: 10.1136/jcp.41.2.207. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Hollanders D. Twice daily tripotassium dicitrato bismuthate in the treatment of duodenal ulceration. Postgrad Med J. 1986 Jan;62(723):19–21. doi: 10.1136/pgmj.62.723.19. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Humphreys H., Bourke S., Dooley C., McKenna D., Power B., Keane C. T., Sweeney E. C., O'Moráin C. Effect of treatment on Campylobacter pylori in peptic disease: a randomised prospective trial. Gut. 1988 Mar;29(3):279–283. doi: 10.1136/gut.29.3.279. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Marshall B. J., Goodwin C. S., Warren J. R., Murray R., Blincow E. D., Blackbourn S. J., Phillips M., Waters T. E., Sanderson C. R. Prospective double-blind trial of duodenal ulcer relapse after eradication of Campylobacter pylori. Lancet. 1988 Dec 24;2(8626-8627):1437–1442. doi: 10.1016/s0140-6736(88)90929-4. [DOI] [PubMed] [Google Scholar]
  9. Marshall B. J., McGechie D. B., Rogers P. A., Glancy R. J. Pyloric Campylobacter infection and gastroduodenal disease. Med J Aust. 1985 Apr 15;142(8):439–444. doi: 10.5694/j.1326-5377.1985.tb113444.x. [DOI] [PubMed] [Google Scholar]
  10. McNulty C. A., Dent J. C., Ford G. A., Wilkinson S. P. Inhibitory antimicrobial concentrations against Campylobacter pylori in gastric mucosa. J Antimicrob Chemother. 1988 Nov;22(5):729–738. doi: 10.1093/jac/22.5.729. [DOI] [PubMed] [Google Scholar]
  11. Oderda G., Dell'Olio D., Morra I., Ansaldi N. Campylobacter pylori gastritis: long term results of treatment with amoxycillin. Arch Dis Child. 1989 Mar;64(3):326–329. doi: 10.1136/adc.64.3.326. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Quintero Diaz M., Sotto Escobar A. Metronidazole versus cimetidine in treatment of gastroduodenal ulcer. Lancet. 1986 Apr 19;1(8486):907–907. doi: 10.1016/s0140-6736(86)91006-8. [DOI] [PubMed] [Google Scholar]
  13. Unidentified curved bacilli on gastric epithelium in active chronic gastritis. Lancet. 1983 Jun 4;1(8336):1273–1275. [PubMed] [Google Scholar]
  14. Van Caekenberghe D. L., Breyssens J. In vitro synergistic activity between bismuth subcitrate and various antimicrobial agents against Campylobacter pyloridis (C. pylori). Antimicrob Agents Chemother. 1987 Sep;31(9):1429–1430. doi: 10.1128/aac.31.9.1429. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES