Practice nurses in Canada News - Part 63

Bismuth-based quadruple therapy with bismuth subcitrate, metronidazole, tetracycline and omeprazole in the eradication of Helicobacter pylori

 eradication of Helicobacter pyloriReports from the Canadian Helicobacter pylori Consensus Conference and from the Ad Hoc Committee on Practice Parameters of the American College of Gastroenterology advocate testing and eradicating H pylori in patients presenting with gastroduodenal ulcers. However, results of a survey indicated that 43% to 66% of American physicians also eradicate H pylori in patients with nonulcer dyspepsia. Over the years, many treatments have been tested for the eradication of H pylori. Among them, the so-called bismuth-based triple-therapy with colloidal bismuth subcitrate, metronidazole and tetracycline (BMT) has been extensively tested with success.

In a previous trial, a 14-day treatment with colloidal bismuth subcitrate 120 mg qid plus metronidazole 250 mg qid plus tetracycline 500 mg qid gave very good eradication rates of 82% and 90% by modified intent-to-treat (MITT) and per protocol analyses, respectively. The influence of metronidazole sensitivity on the eradication rate was, however, not assessed.

In an effort to increase the efficacy of the regimen, a proton pump inhibitor was added. Also, the treatment duration was reduced to seven days, and the amount of tetracycline was lowered to 1 g daily to increase gastrointestinal tolerance. This study, therefore, was designed to assess the efficacy and safety of a seven-day treatment for the eradication of H pylori with colloidal bismuth subcitrate 120 mg qid plus metronidazole 250 mg qid plus tetracycline 250 mg qid, all given 1 h before meals and at bedtime, in addition to omeprazole 20 mg bid with the morning and evening meals.