oxytetracycline--anhydrous and Peptic-Ulcer

Eradication of H. pylori cures peptic ulcer disease. Bismuth and antibiotics in various combinations were tested at a single university hospital.. The standard treatment was bismuth subnitrate, metronidazole and oxytetracycline. A positive biopsy urease test was the main inclusion criterium, whereas a negative 14C-urea breath test performed at least four weeks after cessation of therapy was the main indicator of cured infection, and performed later for reinfection. In separate studies we tested the absorption of bismuth subnitrate compared to other bismuth preparations, what aspects of bismuth-based triple therapy are most important to obtain maximum eradication, what can be done to decrease side effects, and the reliability of diagnostic methods.. The absorption of bismuth from bismuth subnitrate was very low. More than 90% cure rates were usually obtained. Including metronidazole in the regimen increased side effects but was crucial for effectiveness. Spiramycine could replaced oxytetracycline without substantial loss of effectiveness. Effectiveness was decreased if the patients had recently used metronidazole. Aluminium containing antacids and chlorhexidine were not very useful. Side effects were frequent, up to 60%, but usually mild and very few patients withdrew from treatment. Adding ranitidine to the regimen reduced abdominal pain. 14C-urea breath test was the "gold standard" and the specificity of the biopsy urease test in diagnosing H. pylori infection was high.. Bismuth combination therapy combines high effectiveness with acceptable side effects and low cost. Biopsy urease test and urea breath test are reliable indicators of H. pylori infection.

Topics: Antacids; Anti-Bacterial Agents; Anti-Ulcer Agents; Bismuth; Drug Therapy, Combination; Follow-Up Studies; Helicobacter Infections; Helicobacter pylori; Hospitals, University; Humans; Metronidazole; Norway; Oxytetracycline; Peptic Ulcer; Stomach Diseases; Urea; Urease

It is well documented that dyspepsia in patients with peptic ulcer disease (PUD) improves markedly after eradication of Helicobacter pylori, while rarely does it improve in patients with functional dyspepsia. There is a large group of H. pylori-infected patients who do not qualify for either diagnosis, but in whom eradication may be considered. The aim of this study was to compare symptom severity, change in gastrointestinal symptoms 1 year after eradication and satisfaction with therapy between PUD patients and patients with endoscopic diagnoses of gastritis and/or duodenitis (G/D patients).. The patients were randomized to one of four triple regimens containing ranitidine bismuth and metronidazole, and either oxytetracycline or spiramycine. Eradication was assessed with the 14C-urea breath test. GI symptoms were evaluated using the Gastrointestinal Symptom Rating Scale (GSRS) and the Ulcer Esophagitis Subjective Symptoms Scale (UESS) questionnaires.. One-hundred-and-eighty-three patients were recruited from GI outpatient clinics. Patients with PUD and G/D had similar severity of symptoms before eradication therapy. One year after H. pylori eradication, 99% of the PUD patients and 75% of the G/D patients felt better regarding their main upper GI complaint. Abdominal pain score decreased by 48% as measured by GSRS and by 78% as measured by UESS in the PUD group and by 25% and 47%, respectively, in the G/D group. Reflux symptoms decreased by 41% and 63% in PUD patients and by 28% and 45% in G/D patients; indigestion by 30% and 47% in PUD and by 20% and 34% in G/D; eating discomfort by 60% in PUD and by 35% in G/D. Sleep quality score improved by 68% in PUD and by 41% in NU patients. Constipation decreased by 22% in the PUD group. All these differences in symptoms were highly significant compared to baseline. Diarrhoea was unchanged.. Abdominal pain, reflux symptoms, indigestion and the ability to eat and sleep improved in both PUD and G/D patients 1 year after H. pylori eradication. Chronic diarrhoea was not induced. Abdominal pain improved significantly more in PUD than in G/D patients. Further study of the effect of H.pylori eradication in G/D patients is warranted.

Topics: Anti-Bacterial Agents; Anti-Ulcer Agents; Bismuth; Drug Therapy, Combination; Duodenitis; Female; Follow-Up Studies; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Oxytetracycline; Peptic Ulcer; Ranitidine; Spiramycin; Time Factors

180 Helicobacter pylori-positive patients with peptic ulcer disease were randomly allocated to double-blind placebo-controlled treatment with one of four anti-H. pylori regimens consisting of bismuth subnitrate suspension (B), oxytetracycline (OT), metronidazole (M)/metronidazole placebo, or ranitidine (R)/ranitidine placebo.. Regimen 1: B 150 mg q.i.d., OT 500 mg q.i.d., M 400 mg t.i.d. for 10 days and R 300 mg b.i.d. for 4 wk. Regimen 2: same as regimen 1 except ranitidine. Regimen 3: same as regimen 1 except metronidazole. Regimen 4: same as regimen 1 except metronidazole and ranitidine. Gastroscopy and 14C-urea breath test were performed 4 wk after cessation of therapy, and breath test six months after cessation.. According to intention-to-treat analysis, H. pylori eradication rates were 96%, 91%, 20%, and 9% with regimens 1, 2, 3, and 4, respectively. Comparing regimens 1+2 and 3+4, the eradication rates with and without metronidazole were 93% and 14%, respectively (p < 0.0001). Metronidazole increased the occurrence of diarrhea and abdominal pain. Comparing regimens 1+3 with 2+4 ranitidine did not influence H. pylori eradication (58% with and 50% without ranitidine; p = 0.37) or ulcer healing (93% with and 90% without ranitidine; p = 0.72) significantly, but reduced the occurrence of pain (p < 0.01). Six months after treatment, three patients who were H. pylori negative at 4 wk had become positive. These three had all received metronidazole placebo. H. pylori status remained negative in the other 85 patients.. H. pylori eradication with this triple therapy is critically dependent on metronidazole. Adding ranitidine reduces the occurrence of abdominal pain during such therapy.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antacids; Anti-Bacterial Agents; Anti-Ulcer Agents; Bismuth; Drug Therapy, Combination; Female; Helicobacter Infections; Helicobacter pylori; Histamine H2 Antagonists; Humans; Male; Metronidazole; Middle Aged; Oxytetracycline; Palliative Care; Peptic Ulcer; Ranitidine; Treatment Outcome

Spiramycin (Rovamycin) is a well-established macrolide antibiotic with good anti-Helicobacter pylori activity in vitro. It is acid-stable and found in high concentration in various body fluids and cells after oral administration. Its anti-H. pylori activity in vivo has not yet been tested.. Twenty-five consecutive patients with endoscopically verified peptic ulcer and a positive biopsy urease test were given spiramycin tables 1.5 MIU instead of oxytetracycline 500 mg q.d.s. in our triple therapy regimen with bismuth subnitrate suspension 10 mL (150 mg bismuth subnitrate) q.d.s. and metronidazole 400 mg t.d.s. for 10 days. Bismuth was taken between meals and spiramycin and metronidazole with meals. Re-endoscopy and 14C-urea breath test were performed 4 weeks after completion of therapy. Those who were H. pylori negative according to the breath test returned for 1-year follow-up.. Per protocol analysis at 4 weeks showed that 21 out of 23 patients were H. pylori negative and had healed ulcers. These 21 patients were persistingly H. pylori negative and had no ulcers at 1-year follow-up. H. pylori eradication and ulcer healing rates were thus 91.3%; 95% confidence interval from 72.0% to 98.9%. Side-effects limiting daily activity were significantly less frequent than we have experienced previously using oxytetracycline in triple therapy.. Spiramycin appears to be an alternative to tetracycline in the triple therapy of H. pylori infection. Further studies to position spiramycin as an anti-H. pylori drug are warranted.

Topics: Adult; Aged; Bismuth; Breath Tests; Drug Therapy, Combination; Female; Follow-Up Studies; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Oxytetracycline; Peptic Ulcer; Spiramycin; Treatment Outcome

A total of 152 patients with recurrent peptic ulcer disease were treated with bismuth subnitrate, oxytetracycline and metronidazole. The 51 patients in Group 1 were included following a study of the effect of cognitive psychotherapy on the recurrence rate after curative treatment for duodenal ulcer (DU). Group 2 comprised 101 consecutive patients referred to us with recurrent peptic ulcer. Their Helicobacter pylori (Hp) status was assessed before, and 4 weeks after, discontinuation of treatment, using the 14C-urea breath test. The primary aim of the study was to determine the effect of the triple treatment regimen on Hp eradication. All but two patients were Hp-positive prior to treatment. Four weeks after termination of treatment, Hp was found to have been eradicated in 50 out of 51 patients (98%) in Group 1, and in 86 out of 97 patients (89%) in Group 2. The respective ulcer healing rates for the two groups were 100% and 95%. Fifty percent of the patients noted moderate to severe adverse effects, mainly nausea and diarrhea, but only 5 patients discontinued treatment prematurely. The results indicate that virtually all patients with recurrent peptic ulcer disease have gastric Hp infection, and that the present triple treatment is highly effective in terms of both Hp eradication and ulcer healing.

Topics: Adult; Aged; Antacids; Bismuth; Drug Therapy, Combination; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Oxytetracycline; Peptic Ulcer; Recurrence

To evaluate the cure rate of Helicobacter pylori infection, including the impact of in vitro metronidazole resistance (M-R), and the side effects of a simplified 10-day bismuth triple therapy in routine clinical practice.. From September 1995 to March 1996, 248 consecutive H. pylori-positive patients received 10 days of bismuth subnitrate 150 mg, oxytetracycline 500 mg, and metronidazole 400 mg, all t.id. Before treatment, upper endoscopy, including biopsy specimens for microbiological analysis and IgG serology were performed. M-R was found in 45% of females and 36% of males. At least 2 months after treatment, H. pylori status was assessed by the 14C urea breath test (n = 131), endoscopy (n = 37), urea breath test and endoscopy (n = 63), or solely by IgG serology (n = 7). Ten patients withdrew. IgG serology was performed again after 1 yr.. H. pylori infection was cured in 205 patients: 86% by all-patients-treated analysis and 83% by intention-to-treat analysis. When patients were classified according to pretreatment metronidazole susceptibility, cure of infection was achieved in 76% of females harboring M-R strains versus 96% of those with sensitive strains (p = 0.002) and in 81% versus 88% (p = 0.34) of males with M-R versus sensitive strains, respectively. Twelve patients (5 %) had to stop treatment prematurely because of severe side effects, but eight of them were treated successfully. One case of H. pylori infection (0.6 %) was detected at 1-yr follow-up.. Ten-day bismuth triple therapy t.i.d. was effective in curing H. pylori infection in the context of routine clinical practice. The efficacy was reduced in females harboring M-R strains.

Topics: Adult; Aged; Aged, 80 and over; Antacids; Anti-Bacterial Agents; Bismuth; Drug Administration Schedule; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Oxytetracycline; Peptic Ulcer

We treated 143 Helicobacter pylori positive ulcer patients (duodenal ulcer 81, gastric ulcer 24, pyloric ulcer nine, previous duodenal ulcer 27, others two) with a ten days regimen of bismuth subnitrate, oxytetracycline and metronidazole. Four weeks after cessation of treatment the 14C-urea breath test showed that the infection was eradicated in 133 out of 140 patients (95%). The ulcer had healed in 129 (97%) of the H. pylori negative patients. Status at one year after treatment showed that 121 (98.4%) of 123 patients who had become H. pylori negative had remained negative. None of the H. pylori negative patients experienced ulcer relapse. The results show that the treatment is effective and that the rate of recurrence of H. pylori during the first year is very low.

Topics: Adult; Aged; Bismuth; Drug Therapy, Combination; Female; Follow-Up Studies; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Oxytetracycline; Peptic Ulcer; Time Factors

Recent data on peptic ulcer and Helicobacter pylori colonization of the ventricle were discussed. Agreement was reached to re-adjust the pharmacological treatment of this condition. All patients for whom antibiotic therapy is considered should be examined by gastroscope. The bacterial agent should be proved by at least one out of several available methods. Two different established regimens are prescribed, either triple therapy with bismuth, metronidazole and tetracycline or double treatment without bismuth, for instance amoxicillin and omeprazole. Clinical control should take place after about eight weeks, with a "breath-test" in the case of duodenal ulcers, or with gastroscopy and a urease test. Many pointed out that treatment aimed at gastric acid reduction is to be preferred in cases of first occurrence of ventricular ulcers. Long-term acid reduction by drugs should not be offered to a patient until an attempt has been made to eradicate existing bacteria. No patient should be operated on before he being given antibacterial treatment. Treatment of non-ulcer dyspepsia with antibiotics has not shown to have an affect.

Topics: Amoxicillin; Bismuth; Drug Therapy, Combination; Follow-Up Studies; Helicobacter Infections; Helicobacter pylori; Humans; Metronidazole; Norway; Omeprazole; Oxytetracycline; Peptic Ulcer

Topics: Benzimidazoles; Bone and Bones; Coenzymes; Gastric Juice; Oxytetracycline; Peptic Ulcer; Prednisone; Proteins; Vitamin B 12

Topics: Humans; Leptospirosis; Oxytetracycline; Peptic Ulcer