title: Prevention of nitroimidazole resistance in Campylobacter pylori by coadministration of colloidal bismuth subcitrate: clinical and in vitro studies.
abstract: One hundred patients with duodenal ulceration and Campylobacter pylori in their stomach were entered into a double blind placebo controlled prospective study. Treatment schedules were cimetidine and placebo, or cimetidine and tinidazole, or colloidal bismuth subcitrate (CBS) and placebo, or CBS and tinidazole. Seventeen per cent of isolates of C pylori obtained at the first endoscopy were resistant to tinidazole and 70% of the second isolates from patients given cimetidine and tinidazole became tinidazole resistant. Suspensions of nitroimidazole sensitive cultures of C pylori showed that three of 22 isolates had a nitroimidazole resistant subpopulation. In patients who healed and remained free of C pylori after treatment ulcers recurred less often than in patients who healed but retained C pylori (23% v 73% over 12 months, p less than 0.001).
authors.affiliation: Department of Microbiology, Royal Perth Hospital, Western Australia.
authors.forename: C S
authors.initials: CS
authors.lastname: Goodwin
authors.forename: B J
authors.initials: BJ
authors.lastname: Marshall
authors.forename: E D
authors.initials: ED
authors.lastname: Blincow
authors.forename: D H
authors.initials: DH
authors.lastname: Wilson
authors.forename: S
authors.initials: S
authors.lastname: Blackbourn
authors.forename: M
authors.initials: M
authors.lastname: Phillips
mesh_terms: D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D002167:Campylobacter / Q000187:drug effects* / Q000302:isolation & purification; D002169:Campylobacter Infections / Q000150:complications / Q000188:drug therapy; D002927:Cimetidine / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004311:Double-Blind Method; D004352:Drug Resistance, Microbial; D004381:Duodenal Ulcer / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D009593:Nitroimidazoles / Q000627:therapeutic use*; D009942:Organometallic Compounds / Q000627:therapeutic use*; D012008:Recurrence; D014011:Tinidazole / Q000627:therapeutic use*
chemical_list: D000897:Anti-Ulcer Agents; D009593:Nitroimidazoles; D009942:Organometallic Compounds; D014011:Tinidazole; D002927:Cimetidine; C002791:bismuth tripotassium dicitrate