title: Short report: a non-metronidazole triple therapy for eradication of Helicobacter pylori infection--tetracycline, amoxicillin, bismuth.
abstract: Triple therapies using bismuth, metronidazole and tetracycline or amoxicillin were the first truly successful anti-H. pylori therapies. Metronidazole resistance has become an increasing problem that has severely limited the usefulness of the original triple therapy. Resistance to tetracycline or amoxicillin has not been reported and both are effective against H. pylori. We therefore tested a new triple therapy consisting of 500 mg tetracycline, 500 mg amoxicillin, and 2 tablets of bismuth subsalicylate each administered four times daily (with meals and at bedtime) for 14 days during treatment with ranitidine 300 mg daily. H. pylori eradication was defined as no evidence of H. pylori one or more months after stopping therapy. H. pylori status was evaluated by a combination of urea breath test and histology. Sixteen patients with H. pylori infection and active peptic ulcers were enrolled. The new triple therapy was successful in only 7 individuals (43%). Metronidazole appears to be critical for the effectiveness of the original triple therapy. An alternative to metronidazole will be required for a new successful triple therapy.
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: G M
authors.initials: GM
authors.lastname: Lew
authors.forename: F C
authors.initials: FC
authors.lastname: Ramirez
authors.forename: R M
authors.initials: RM
authors.lastname: Genta
authors.forename: P D
authors.initials: PD
authors.lastname: Klein
authors.forename: H M
authors.initials: HM
authors.lastname: Malaty
mesh_terms: D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use*; D001729:Bismuth; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D004381:Duodenal Ulcer / Q000188:drug therapy / Q000382:microbiology; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D009942:Organometallic Compounds / Q000627:therapeutic use*; D012459:Salicylates / Q000627:therapeutic use*; D013276:Stomach Ulcer / Q000188:drug therapy / Q000382:microbiology; D013752:Tetracycline / Q000627:therapeutic use*
chemical_list: D009942:Organometallic Compounds; D012459:Salicylates; D008795:Metronidazole; C015715:bismuth subsalicylate; D000658:Amoxicillin; D013752:Tetracycline; D001729:Bismuth