Three-in-one therapy targets H. pylori

August 6, 2007

In effort to improve H. pylori eradication rates, Axcan Pharma has harnessed the power of three drugs known to have antimicrobial effects and combined them into a novel 3-in-1 formulation. Marketed under the trade name Pylera, the new product contains 140 mg bismuth subcitrate potassium, 125 mg metronidazole, and 125 mg tetracycline in each capsule. Pylera is indicated for use in combination with omeprazole for treating H. pylori infection and duodenal ulcer disease.

We now know this is not the case, but it was not easy to change a medical paradigm. In fact, in the mid-1980s, Australian physician Barry Marshall resorted to ingesting the bacterium Helicobacter pylori to illustrate what he had discovered in the laboratory-that H. pylori was often the cause of gastritis and peptic ulcer disease. In 2005, two decades later, Marshall and J. Robin Warren shared the Nobel Prize in Medicine for their discovery of H. pylori.

Axcan Pharma has now harnessed the power of three drugs known to have antimicrobial effects, combining them into a novel formulation. Approved last year and now marketed under the trade name Pylera, the new capsule contains 140 mg bismuth subcitrate potassium, 125 mg metronidazole, and 125 mg tetracycline. It is indicated for use in combination with omeprazole for treating H. pylori infection and duodenal ulcer disease. According to Rosemary Berardi, Pharm.D., a professor of pharmacy at the University of Michigan, "The product's main advantage is that it incorporates a nonsalicylate salt as its source of bismuth, thus avoiding the side effects and cautions associated with bismuth salicylate and the need to take the bismuth salt separately."

Three capsules of Pylera should be taken four times daily after meals and at bedtime for 10 days. Additionally, 20 mg omeprazole should be taken at breakfast and dinner to reduce the amount of secreted acid, provide symptomatic relief, and aid in healing. "The addition of a twice-daily proton pump inhibitor permits a shorter duration of treatment [10 days], compared with older four-drug regimens that contained an H2-receptor antagonist," said Berardi.

Adverse effects of Pylera are often gastrointestinal in nature, with stool abnormality, diarrhea, dyspepsia, abdominal pain, and nausea reported most frequently. This regimen may be simpler than other four-drug H. pylori regimens, said Berardi, but the patient must still take three or four capsules four times a day compared with the proton-pump inhibitor-based three-drug regimens taken twice daily that provide similar eradication rates.

TIPS TO REMEMBER Pylera

THE AUTHOR is a clinical writer based in the Philadelphia area.