Tetracyclines ulceration therapy

Tetracycline - A6 unct ve therapy for peptic ulcers due to Helicobacter pylori (500 mg 4 times/day). 

Crowson TD, Head LH, Ferrante WA. Esophageal ulcers associated with tetracycline therapy. JAMA 1976 235(25) 2747-8. 

It is fascinating to note the recent re-awakening of interest in bismuth therapies since the discovery in 1982 that the intestinal bacterium Helicobacter pylori may well initiate ulcer formation by excreting acid. Bismuth, in common with many heavy metals, is bactericidal and so the lasting effects of bismuth citrate therapy may well be a combination of ulcer healing (from the precipitates) as well as ulceration initiator suppression (from the bacteriocidal action). In vitro the organism is sensitive to bismuth but results in vivo are feeble. However, combinations of bismuth with antibiotics such as amoxicillin or tetracycline have success rates of 80%, i.e. four times the 20% success rate described above. 

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. 

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