To recipes helpdesk

Question

Posted on: March 6 2013

A doctor asks me to prepare capsules with bismuth, possibly magijet. These would be used in a combination therapy for the eradication of Helicobacter Pylori.

< br/>

Answer

When you consult the link below, you will find the original article, which discusses this combination therapy. http://www.med.upenn.edu/gastro/documents/HpyloriQuadtherapylancet2011.pdf Potassium bismutsubcitrate is apparently used. This product, which distinguishes itself by a greater solubility in water, of bismuth subcarbonate or nitrate, is not available in Belgium. But in the magazine Helicobacter. 2000 Sep; 5 (3): 176-82 We read:

Solubility, absorption, and anti-Helicobacter pylori activity of bismuth subnitrate and colloidal bismuth subcitrate: In vitro data Do not predict In vivo efficacy. Phillips RH, Whitehead MW, Lacey S, Champion M, Thompson RP, Powell JJ.

Gastrointestinal Laboratory, The Rayne Institute, St. Thomas ' Hospital, London, UK.

Abstract

OBJECTIVES: The aim of this study was to compare the dissolution, bioavailability, and anti-Helicobacter pylori activity of bismuthsubnitrate and colloidal bismuth subcitrate. This could, first, provide insights into the mechanism of action of bismuth and, second, help to develop optimal therapeutic strategies.

METHODS: Solubility and aquated size of bismuth species were determined in human gastric juice, while absorption into blood and urinary excretion of bismuth was determined in volunteers. Activity against H. pylori was determined in vitro in the presence and absence of antibiotics, while H. pylori eradication was compared in vivo.

RESULTS: Bismuth from colloidal Bismuth are was at least 10% soluble and ultrafilterable and was absorbed in volunteers (> 0.5%), whereas that from Bismuth Subnitrate was insoluble and not absorbed (< 0.01%). Colloidal bismuth are was active against H. pylori (mean inhibitory concentration, 400 Microg/ml); Neither was synergistic with antibiotics. With in vivo triple therapy, bismuth subnitrate was as effective as colloidal bismuth are in eradicating H. pylori (74% and 70% eradicated, respectively).

CONCLUSIONS: Colloidal bismuth subcitrate, unlike bismuth subnitrate, is partially soluble, absorbed in humans, and directly toxic to H. pylori in vitro. Surprisingly, however, these preparations had similar efficacy in vivo against H. pylori within triple therapy, suggesting that bismuth compounds may also exhibit indirect antimicrobial effects. We propose that this is an effect on the gastric mucus layer. Nonabsorbable bismuth compounds should be preferentially considered in bismuth-based therapies against H. pylori, as they would minimize toxicity while maintaining efficacy.

The capsules Pylera TM : (Bismuth are potassium, metronidazole, and tetracycline hydrochloride) 140 mg/125 mg/125mg could serve as an example with replacement of the substrate by the subcarbonate that might still be preferable is above the nitrate.