Bismuth Compounds for Eradication of &lt;i&gt;Helicobacter pylori&lt;/i&gt;: Pharmacology and Safety

Scarpignato, Carmelo; Pelosini, Iva

doi:10.1159/000061963

Cited by 12 publications

(25 citation statements)

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“…A large number of in vitro studies have evaluated the effect of bismuth on various critical H. pylori functions 59. However, in vivo and in vitro observations correlate poorly possibly because in vivo studies are done in acidic conditions and most in vitro studies require neutral pH 59 63 66–72. Armstrong et al 73 evaluated bismuth subcitrate and antibiotics (separately) on viability and ultrastructure of H. pylori in vitro .…”

Section: Understanding the Variation In Outcome With Triple Therapy Pmentioning

confidence: 99%

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Role of bismuth in improvingHelicobacter pylorieradication with triple therapy

Dore

Lü

Graham

2016

Gut

216

248

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In most regions of the world, antimicrobial resistance has increased to the point where empirical standard triple therapy for Helicobacter pylorieradication is no longer recommended. The treatment outcome in a population is calculated as the sum of the treatment success in the subpopulation with susceptible infections plus treatment success in the subpopulation with resistant infections. The addition of bismuth (i.e., 14-day triple therapy plus bismuth) can improve cure rates despite a high prevalence of antimicrobial resistance. The major bismuth effect is to add an additional 30%-40% to the success with resistant infections. The overall result is therefore dependent on the prevalence of resistance and the treatment success in the subpopulation with resistant infections (eg, with proton-pump inhibitor-amoxicillin dual therapy). Here, we explore the contribution of each component and the mechanisms of how bismuth might enhance the effectiveness of triple therapy. We also discuss the limitations of this approach and provide suggestions how triple therapy plus bismuth might be further improved.

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Section: Understanding the Variation In Outcome With Triple Therapy Pmentioning

confidence: 99%

“…It has also been suggested that bismuth be administered with meals to enhance it distribution throughout the stomach 59 83 84. The recent clinical trials in China have administered bismuth 30 min before meals.…”

Section: Understanding the Variation In Outcome With Triple Therapy Pmentioning

confidence: 99%

Role of bismuth in improvingHelicobacter pylorieradication with triple therapy

Dore

Lü

Graham

2016

Gut

216

248

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“…Of the Gram-negative rods, identified in patients with GI disease, those belonging to the Enterobacteriaceae family appear to be the most sensitive ones [49,50]. Interestingly enough, rifaximin was found to inhibit the growth of H. pylori [51][52][53][54] with MIC values (table 1) intermediate between those of amoxicillin and colloidal bismuth subcitrate [55]. In contrast to metronidazole, no strain tested exhibited primary resistance [52,53].…”

Section: In Vitro Activitymentioning

confidence: 99%

“…Its development leads to a further reduction in the effective arterial blood volume, and it has a mortality rate equivalent to that of a variceal bleed [202]. Since hepatic blood flow and func- 55 tion are age-dependent [203], SBP could be particularly severe in the elderly.…”

Section: Prevention Of Spontaneous Bacterial Peritonitis In Cirrhosismentioning

confidence: 99%

Rifaximin, a Poorly Absorbed Antibiotic: Pharmacology and Clinical Potential

2005

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Rifaximin (4-deoxy-4′-methylpyrido[1′,2′-1,2]imidazo- [5,4-c]-rifamycin SV) is a synthetic antibiotic designed to modify the parent compound, rifamycin, in order to achieve low gastrointestinal (GI) absorption while retaining good antibacterial activity. Both experimental and clinical pharmacology clearly show that this compound is a nonsystemic antibiotic with a broad spectrum of antibacterial action covering Gram-positive and Gram-negative organisms, both aerobes and anaerobes. Being virtually nonabsorbed, its bioavailability within the GI tract is rather high with intraluminal and fecal drug concentrations that largely exceed the minimal inhibitory concentration values observed in vitro against a wide range of pathogenic organisms. The GI tract represents, therefore, the primary therapeutic target and GI infections the main indication. The appreciation of the pathogenic role of gut bacteria in several organic and functional GI diseases has increasingly broadened its clinical use, which is now extended to hepatic encephalopathy, small intestine bacterial overgrowth, inflammatory bowel disease and colonic diverticular disease. Potential indications include the irritable bowel syndrome and chronic constipation, Clostridium difficile infection and bowel preparation before colorectal surgery. Because of its antibacterial activity against the microorganism and the lack of strains with primary resistance, some preliminary studies have explored the rifaximin potential for Helicobacter pylori eradication. Oral administration of this drug, by getting rid of enteric bacteria, could also be employed to achieve selective bowel decontamination in acute pancreatitis, liver cirrhosis (thus preventing spontaneous bacterial peritonitis) and nonsteroidal anti-inflammatory drug (NSAID) use (lessening in that way NSAID enteropathy). This antibiotic has, therefore, little value outside the enteric area and this will minimize both antimicrobial resistance and systemic adverse events. Indeed, the drug proved to be safe in all patient populations, including young children. Although rifaximin has stood the test of time, it still attracts the attention of both basic scientists and clinicians. As a matter of fact, with the advancement of the knowledge on microbial-gut interactions in health and disease novel indications and new drug regimens are being explored. Besides widening the clinical use, the research on rifaximin is also focused on the synthesis of new derivatives and on the development of original formulations designed to expand the spectrum of its clinical use.

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“…A number of different bismuth‐based preparations are available, such as bismuth subsalicylate, which is commonly used in the United States [3], and bismuth subnitrate and colloidal bismuth subcitrate, which are mainly used in Europe [2,4]. Review of different studies suggests that the chemical form, solubility, and absorption characteristics of these bismuth preparations may differ significantly [3], although direct comparisons have not been made. Surprisingly, H. pylori eradication rates in different countries appear comparable with all bismuth‐based regimes, irrespective of the physical and chemical form of bismuth [3].…”

mentioning

confidence: 99%

Solubility, Absorption, and Anti–Helicobacter pylori Activity of Bismuth Subnitrate and Colloidal Bismuth Subcitrate: In Vitro Data Do Not Predict In Vivo Efficacy

et al. 2000

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Colloidal bismuth subcitrate, unlike bismuth subnitrate, is partially soluble, absorbed in humans, and directly toxic to H. pylori in vitro. Surprisingly, however, these preparations had similar efficacy in vivo against H. pylori within triple therapy, suggesting that bismuth compounds may also exhibit indirect antimicrobial effects. We propose that this is an effect on the gastric mucus layer. Nonabsorbable bismuth compounds should be preferentially considered in bismuth-based therapies against H. pylori, as they would minimize toxicity while maintaining efficacy.

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Bismuth Compounds for Eradication of <i>Helicobacter pylori</i>: Pharmacology and Safety

Cited by 12 publications

References 0 publications

Role of bismuth in improvingHelicobacter pylorieradication with triple therapy

Role of bismuth in improvingHelicobacter pylorieradication with triple therapy

Rifaximin, a Poorly Absorbed Antibiotic: Pharmacology and Clinical Potential

Solubility, Absorption, and Anti–Helicobacter pylori Activity of Bismuth Subnitrate and Colloidal Bismuth Subcitrate: In Vitro Data Do Not Predict In Vivo Efficacy

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