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Diarrhea (Traveler's)
Published in Charles Theisler, Adjuvant Medical Care, 2023
Bismuth subsalicylate (BSS), as in Pepto-Bismol, may be considered for any traveler to prevent traveler’s diarrhea. BSS has been studied using four divided doses of either 2.1 gm/day or 4.2 gm/day (with meals and at bedtime). A lower divided dose of 1.05 gm/day has also been shown to be preventive, although it is unclear whether it is as effective as the higher doses.4 Research shows that taking bismuth subsalicylate the day before traveling and continuing until two days after returning home reduces the risk of traveler’s diarrhea by up to 41%.5
Immunosuppressants, rheumatic and gastrointestinal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
The mechanism of action of bismuth-containing agents (e.g. bismuth subsalicylate, bismuth subnitrate or bismuth subgallate) remains largely unknown. Studies have shown that bismuth subsalicylate inhibits intestinal secretion caused by cholera toxins and enterotoxic E. coli. In children with acute diarrhoea, studies have shown that treatment with bismuth subsalicylate reduces the frequency of unformed stools and the duration of diarrhoea [15]. Reports of encephalopathy occurring during ingestion of bismuth-containing compounds [16] led to prohibition of bismuth containing agents in France.
Helicobacter pylori
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Furazolidone quadruple therapy with tetracycline Bismuth subsalicylate or bismuth subcitrate two tablets and tetracycline hydrochloride (500 mg) both 4 times daily with meals and at bedtime plus furazolidone 100 mg 8-hourly with meals and PPI twice daily for 14 days.Furazolidone quadruple therapy with amoxicillin Bismuth subsalicylate or bismuth subcitrate two tablets 4 times daily with meals and at bedtime plus furazolidone 100 mg and amoxicillin 1 g 8-hourly, with meals plus a PPI twice daily for 14 days.
Factors associated with treatment failure, and possible applications of probiotic bacteria in the arsenal against Helicobacter pylori
Published in Expert Review of Anti-infective Therapy, 2023
Amir Hossein Miri, Mojtaba Kamankesh, Mazda Rad-Malekshahi, Abbas Yadegar, Maryam Banar, Michael R. Hamblin, Ismaeil Haririan, Hamid Asadzadeh Aghdaei, Mohammad Reza Zali
BQT consists of a standard dose of a PPI twice a day, metronidazole (500 mg) three times daily, bismuth subsalicylate (525 mg), and tetracycline (250–500 mg) all given four times daily over 14 days [43]. Moreover, BQT could be modified by substitution of amoxicillin for tetracycline. In this regard, a meta-analysis study by Bang et al. [44] confirmed that successful H. pylori eradication could be achieved by using either BQT or modified BQT (20 mg rabeprazole+1 g amoxicillin+500 mg metronidazole+300 mg bismuth subcitrate) regimens in regions with a high level of clarithromycin and metronidazole resistance. The eradication rates were as follows: modified BQT: 87.2% vs BQT: 82.2%, intention-to-treat (ITT) analysis; modified BQT: 96.2% vs BQT: 96%, modified ITT analysis; (modified BQT: 96.2% vs BQT: 96.9%, per-protocol (PP) analysis). This suggests that the modified-BQT regimen shows good potential to control H. pylori infection.
Re-establishing the utility of tetracycline-class antibiotics for current challenges with antibiotic resistance
Published in Annals of Medicine, 2022
Kerry L. LaPlante, Abhay Dhand, Kelly Wright, Melanie Lauterio
All tetracycline-class drugs, including the third-generation agents, come with warnings and precautions including tooth discolouration and enamel hypoplasia during tooth development (last half of pregnancy up until 8 years of age), and inhibition of bone growth (second trimester of pregnancy until 8 years of age). Tigecycline also has a boxed warning for increased mortality risk and should be reserved for situations when alternative treatments are not suitable [10]. Other tetracycline-class AEs include photosensitivity, pseudotumor cerebri, and anti-anabolic action. As seen with other drug classes, while these AEs are attributed to the tetracycline class as a whole, the magnitude of the effect varies between specific drugs within the class (e.g. photosensitivity [71]). Tetracycline-class drugs have been shown to depress plasma prothrombin activity; patients taking anticoagulants may therefore need to be monitored or have their oral anticoagulant dosage adjusted while taking tetracycline-class drugs [9,10,12]. There is impaired absorption of oral tetracycline-class drugs by antacids containing aluminium, calcium, or magnesium, bismuth subsalicylate, and iron-containing preparations [9].
Bismuth containing quadruple therapy versus tailored therapy as first-line treatments for Helicobacter pylori infection in a high clarithromycin resistance area
Published in Scandinavian Journal of Gastroenterology, 2021
Boram Cha, Byoung Wook Bang, Jong Beom Shin, Eun Jung Ko, Weonjin Ko, Kye Sook Kwon, Yong Woon Shin, Young Ju Suh, Hyungkil Kim
The recent Maastricht V consensus conference recommended clarithromycin susceptibility testing when considering clarithromycin triple therapy as a first-line therapy, except in areas with low clarithromycin resistance rates (<15%) [4]. On the other hand, in areas with high clarithromycin resistance rates, bismuth quadruple therapy (BQT; bismuth subsalicylate, tetracycline, metronidazole, and PPI) has been recommended as a first-line empirical therapy because its efficacy is unaffected by clarithromycin resistance [4–6]. In Korea, the 3rd Clinical Practice Guideline for H. pylori published in 2013 recommended clarithromycin triple therapy as the first-line therapy, despite falling eradication rates, and also that BQT be considered as the first-line regimen in areas of high clarithromycin resistance [6]. In Korea, clarithromycin resistance varies regionally from 8.5 to 37.5% and has been increasing over recent years [7–9]. Accordingly, testing for clarithromycin resistance is becoming increasingly important prior to treatment decision making.