Urease-producing bacteria inhibiting

Neomycin and metronidazole both inhibit urease-producing bacteria and are useful, but their longterm use is limited by toxicity. 

Inhibiting the activity of urease-producing bacteria by using neomycin, metronidazole, or vancomycin can decrease production of ammonia. Neomycin at doses of 2 to 8 g daily in divided oral doses results in clinical improvement in as many as 80% of patients. At these doses, however, absorption is 1% to 5% and can result in irreversible ototoxicity and nephrotoxicity. As such, even though efficacy is equivalent to lactulose, neomycin should not be first-line therapy. Metronidazole produces response rates similar to neomycin, but side effects, particularly gastrointestinal, limit its use. In patients... 

Acetohydroxamic acid (250 mg p.o. t.i.d.), an antiurolithic agent, is indicated as an adjunctive agent in treating chronic urinary tract infections caused by urease-producing bacteria. Acetohydroxamic acid, which inhibits urease and reduces the production of ammonia, is devoid of antibacterial activity. 

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