[Influence of colloidal bismuth subcitrate, metronidazole, and amoxycillin on Helicobacter pylori and gastroduodenal ulcer healing].

In many works performed in different countries, including Cuba, the microorganism Helicobacter pylori (Hp) is involved in the etiopathogenesis and relapse of gastroduodenal ulcer (GDU). In a previous work, we saw that under treatment of Colloidal bismuth subcitrate (CBS) or Metronidazole (M) alone during 4 weeks, the percentage of Hp clearance obtained was very low. So, we decided to extend the treatment with a unique drug up to 6 weeks or to make a combination of drugs during 4 weeks. 114 patients with GDU endoscopic diagnosis and Hp positive by urease test antral biopsy were located in 5 schedules of treatment: 1) CBS 480 mg daily during 6 weeks; 2)M 1 g daily during 6 weeks; 3) CBS 480 mg daily plus M 750 mg daily during 4 weeks; 4) CBS 480 mg daily plus Amoxycillin (A) 1500 mg daily during 4 weeks and 5) M 750 mg daily plus Amoxycillin 1500 daily during 4 weeks. Endoscopy and urease test were repeated at the end of treatment. Healing of ulcer was obtained in 83.3%; 36.4%; 89.2%; 91.9% and 54.6% respectively. Hp clearance was reached in 55.6%; 27.3%; 67.6%; 70.3% and 27.3% respectively. So, the schedules of treatment less effective (concerning both healing and Hp clearance) were M during 6 weeks and M plus A during 4 weeks. It has been reported that Hp strains may become resistant to nitroimidazolics in the course of treatment and that this resistance could be diminished by the coadministration of CBS. We recommend in GDU-Hp positive a treatment with CBS during 6 weeks or the combination of CBS, which action is basically local, with an antibiotic such as M (no more than two weeks) or Amoxycillin during 4 weeks.