Tetracycline Bismuth subsalicylate

H. pylori [269]. Multiple studies investigating azithromycin in combination with one or two other drugs (amoxicillin, metronidazole, tinidazole, tetracycline, bismuth subsalicylate, and/or a PPl) revealed that the more effective azithromycin-containing regimens involved triple therapy [270-275]. In contrast to clarithromycin, azithromycin is not FDA approved for treatment of H. pylori disease. The role of azithromycin in the treatment of H. pylori remains to be defined. Several in vitro and animal studies have suggested that azithromycin may be clinically active in the treatment of early Lyme disease (LD) [276-278], Several clinical trials of treatment of early Lyme disease performed in the United States and Europe comparing azithromycin vs. doxycycline, oral penicillin, amoxicilUn/ probenicid, or oral amoxicillin revealed no significant difference in clinical outcome [279-283]. The precise role and dose of azithromycin in the treatment of early LD remains to be established. 

Omeprazole 40 mg twice Bismuth subsalicyl- Metronidazole Tetracycline 500 mg four... 

Helidac therapy combines bismuth subsalicylate, metronidazole, and tetracycline in a consumer-tested, patient-friendly kit. 

Bismuth Subsalicylate (Pepto-Bismol) [Antidiarrheal/ Adsorbent] [OTC] Uses Indigestion, N, D combo for Rx of H. pylori Infxn Action Antisecretory anti-inflammatory E>o e Adults. 2 tabs or 30 mL PO PRN (max 8 doses/24 h) Feds. 3—6 y 1/3 tab or 5 mL PO PRN (max 8 doses/24 h) 5-9 y 2/3 tab or 10 mL PO PRN (max 8 doses/24 h) 9-72 y 1 tab or 15 mL PO PRN (max 8 doses/24 h) Caution [C, D (3rd tri), -] Avoid w/ renal failure Hx severe GI bleed Contra Influenza or chickenpox (T risk of Reye synd), ASA allergy (see Aspirin) Disp Chew tabs, caplets, Liq, susp SE May turn tongue stools black Interactions T Effects OF ASA, MTX, valproic acid effects OF tetracyclines i effects W/ corticosteroids, probenecid EMS Monitor for hypovolemia and electrolyte disturbances d/t D may darken tongue stool OD Similar to ASA OD V, tinnitus, metabolic acidosis activated charcoal may be effective... 

Two bismuth compounds are available bismuth subsalicylate, a nonprescription formulation containing bismuth and salicylate, and bismuth subcitrate potassium. In the USA, bismuth subcitrate is available only as a combination prescription product that also contains metronidazole and tetracycline for the treatment of H pylori. Bismuth subsalicylate undergoes rapid dissociation within the stomach, allowing absorption of salicylate. Over 99% of the bismuth appears in the stool. Although minimal (< 1%), bismuth is absorbed it is stored in many tissues and has slow renal excretion. Salicylate (like aspirin) is readily absorbed and excreted in the urine. 

Aluminum Hydroxide Magnesium Trisilicate (Gaviscon) Aluminum Hydroxide (Amphojel, ALtemaGEL) Aluminum Hydroxide + Magnesium Carbonate (Gaviscon Extra Strength, Liquid) Antidiarrheals Bismuth Subcitrate/ Metronidazole/ Tetracycline (Pylera) Bismuth Subsalicylate (Pepto-Bismol) Diphenoxylate w/ Atropine (Lomotil, Lonox)... 

Omeprazole 40 mg twice daily Bismuth subsalicylate 525 mg Metronidazole 250-500 mg Tetracycline 500 mg four times daily... 

Omeprazole amoxicillin + clarithromycin or tetracycline HCL + metronidazole + bismuth subsalicylate... 

Tetracycline HCL + clarithromycin + bismuth subsalicylate amoxicillin + metronidazole + bismuth subsalicylate amoxicillin + clarifliromycin... 

Quadruple therapy x 14 days. Proton pump inhibitor twice a day -l- metronidazole 500 mg three times daily -I- (bismuth subsalicylate 525 mg -l- tetracycline 500 mg four times daily)... 

Bismuth subsalicylate reduces the absorption of tetracycline by 34% and reduces the maximum serum levels of doxycycline by 50%. ° It has been suggested the excipient Veegum (magnesium aluminium silicate) in some bismuth subsalicylate formulations enhances this effect." Bismuth carbonate similarly interacts with the tetracyclines in vitro... 

Albert KS, Welch RD, De Sante KA, Disanto AR. Decreased tetracycline bioavailability caused by a bismuth subsalicylate antidarrheal mixture, JPharm Sci (1979) 68, 586-8. 

Causative agent for peptic ulcers and stomach canco treatable with clarithromycin acid-staNe macrolide) and omeprazole (acid-lowering. cellular proton-pump irthibicor). NIH recently recommended 3 triple-drug therapy consisting of metronidizole, tetracycline (or alternatively, amoxicillin), and bismuth subsalicylate. 

Used in treatment of symptomatic trichomoniasis, acute intestinal amoebiasis, and serious anaerobic infKtions used to treat other sen-ous anaertdiic infiKtions Helidac b a combination drug of bismuth subsalicylate, tetracycline, and metronidazole for neatment of HelicobaaeT pylon. 

Diagnosis of metronidazole resistance requires /n vitro culture. Under such circumstances, a PPI, along with a standard classical tripletherapy regime, such as colloidal bismuth subcitrate or bismuth subsalicylate, with a nitro-imidazole and either tetracycline or amoxicillin may be considered. 

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