title: Simple noninvasive method to test efficacy of drugs in the eradication of Helicobacter pylori infection: the example of combined bismuth subsalicylate and nitrofurantoin.
abstract: Eradication of Helicobacter pylori infections has proved to be difficult. There is a need both for improved therapies and for ways to rapidly identify therapies that show sufficient promise to be worth pursuing. The objectives of this study were to evaluate the value of a therapeutic regimen of a bismuth salt plus nitrofurantoin for eradication of infection by H. pylori and to determine the validity/utility of the urea breath test in monitoring the progress of a clinical trial. We used an 80% eradication rule to define a promising therapeutic regimen, i.e., a regimen that eradicated the infection (no evidence of infection by H. pylori 4 wk after termination of therapy) in at least 80% of the individuals treated. Eighteen men (median age 38) with documented infection by H. pylori completed the study. At the end-of-study evaluation, H. pylori infection was eradicated (negative urea breath test, culture, and histology) in only one of 18 (5.5%) subjects; 15 were positive by the urea breath test, 16 by culture, 15 by Warthin-Starry stain, and 16 by the presence of acute-on-chronic inflammation. Using the 80% eradication rule, any one of these tests alone would have identified that the combination of antimicrobials tested was not effective in the eradication of the infection. We conclude that the urea breath test is a simple, noninvasive, cost-effective method to separate promising from unpromising candidate therapies and for the evaluation of new therapeutic concepts.
authors.affiliation: Department of Medicine, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas.
authors.forename: D Y
authors.initials: DY
authors.lastname: Graham
authors.forename: P D
authors.initials: PD
authors.lastname: Klein
authors.forename: D G
authors.initials: DG
authors.lastname: Evans
authors.forename: D J
authors.initials: DJ
authors.lastname: Evans
authors.forename: L C
authors.initials: LC
authors.lastname: Alpert
authors.forename: A
authors.initials: A
authors.lastname: Opekun
authors.forename: G R
authors.initials: GR
authors.lastname: Jerdack
authors.forename: D R
authors.initials: DR
authors.lastname: Morgan
mesh_terms: D000328:Adult; D001729:Bismuth / Q000627:therapeutic use*; D001944:Breath Tests; D004359:Drug Therapy, Combination; D004797:Enzyme-Linked Immunosorbent Assay; D005756:Gastritis / Q000188:drug therapy / Q000382:microbiology; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D009582:Nitrofurantoin / Q000627:therapeutic use*; D009942:Organometallic Compounds / Q000627:therapeutic use*; D012459:Salicylates / Q000627:therapeutic use*; D014508:Urea
chemical_list: D009942:Organometallic Compounds; D012459:Salicylates; C015715:bismuth subsalicylate; D014508:Urea; D009582:Nitrofurantoin; D001729:Bismuth