Effects of Bismuth Exposure on the Human Kidney—A Systematic Review

Pelepenko, Lauter Eston; Janini, Ana Cristina Padilha; Gomes, Brenda P. F. A.; Soares, Adriana de Jesus; Marciano, Marina Angélica

doi:10.3390/antibiotics11121741

Cited by 10 publications

(4 citation statements)

References 95 publications

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“…In the areas of low CAM resistance, bismuth quadruple therapy or triple therapy with PPI, CAM, and AMPC is recommended as first-line empirical treatment. Bismuth is reported to have nephrotoxicity in patients with renal impairment [35], and it might be safer to avoid bismuth. The generally recommended first-line eradication regimen should be modified in patients with decreased renal function.…”

Section: Discussionmentioning

confidence: 99%

Helicobacter pylori Eradication Therapy in Patients with Decreased Renal Function: A Systematic Review

Nishizawa,

Sano,

Toyoshima

et al. 2024

JCM

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Background: There are concerns that Helicobacter pylori eradication therapy may worsen kidney function in patients with decreased renal function. This study aimed to systematically review the literature regarding Helicobacter pylori eradication in patients with renal impairment. Methods: PubMed, the Cochrane Library, and Igaku Chuo Zasshi were searched for comparative studies on H. pylori eradication in patients with renal impairment. Results: Five articles were included in this systematic review. According to a randomized trial comparing a proton pump inhibitor (PPI) + clarithromycin + metronidazole and PPI + clarithromycin + amoxicillin in patients with decreased renal function, the incidence of acute renal failure was significantly lower in PPI + clarithromycin + metronidazole (2%: 1/44) than in PPI + clarithromycin + amoxicillin (18%: 8/44). The eradication rate in PPI + clarithromycin + metronidazole (92.5%) was significantly better than that in PPI + clarithromycin + amoxicillin (76.3%). According to four reports on eradication treatment using PPI + clarithromycin + amoxicillin in patients with and without decreased renal function, the eradication rates and adverse effects were similar in both groups. Regarding dose adjustment, three reports reduced the dose of antibiotics by half in patients with a creatinine clearance of 30 mL/min or less. Conclusions: The regimen with PPIs, clarithromycin, and metronidazole is recommended for renal impairment. The combination of PPIs, clarithromycin, and amoxicillin, at reduced doses depending on the renal function, is also a potential option.

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Section: Discussionmentioning

confidence: 99%

Helicobacter pylori Eradication Therapy in Patients with Decreased Renal Function: A Systematic Review

Nishizawa,

Sano,

Toyoshima

et al. 2024

JCM

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“…In humans, it is known that exposure to excessive bismuth concentrations can lead principally to renal failure associated with degeneration and necrosis of the renal proximal tubules epithelium, liver necrosis, reversible dysfunction of the nervous system, pigmentation of the gums and intestine, and skin eruptions [98,99].…”

Section: Clinical Evidencesmentioning

confidence: 99%

Bioactive Bismuth Compounds: Is Their Toxicity a Barrier to Therapeutic Use?

Gonçalves,

Matias,

Salvador

et al. 2024

IJMS

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Bismuth compounds are considered relatively non-toxic, with their low solubility in aqueous solutions (e.g., biological fluids) being the major contributing factor to this property. Bismuth derivatives are widely used for the treatment of peptic ulcers, functional dyspepsia, and chronic gastritis. Moreover, the properties of bismuth compounds have also been extensively explored in two main fields of action: antimicrobial and anticancer. Despite the clinical interest of bismuth-based drugs, several side effects have also been reported. In fact, excessive acute ingestion of bismuth, or abuse for an extended period of time, can lead to toxicity. However, evidence has demonstrated that the discontinuation of these compounds usually reverses their toxic effects. Notwithstanding, the continuously growing use of bismuth products suggests that it is indeed part of our environment and our daily lives, which urges a more in-depth review and investigation into its possible undesired activities. Therefore, this review aims to update the pharmaco-toxicological properties of bismuth compounds. A special focus will be given to in vitro, in vivo, and clinical studies exploring their toxicity.

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“…Currently, standard triple or quadruple therapy is commonly employed clinically for H. pylori infection, which includes two antibiotics and a proton pump inhibitor (PPI), with quadruple therapy adding bismuth salts to this regimen. Although the above methods are effective in eradicating H. pylori , they still face many challenges and shortcomings, such as the problem of antibiotic resistance rate [ 6 ], the safety of bismuth agents [ 7 ], the limitations of some of the PPI formulations, and patient compliance [ 8 ], among others. Therefore, there is still a need for further expansion of treatment methods for H. pylori infection.…”

Section: Introductionmentioning

confidence: 99%

Screening Probiotics for Anti-Helicobacter pylori and Investigating the Effect of Probiotics on Patients with Helicobacter pylori Infection

Yang,

Lin,

et al. 2024

Foods

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Probiotics are natural microbial agents with beneficial properties such as bacteriostatic and anti-infective properties. Lactobacillus plantarum Q21, Q25 and QA85, were isolated from the Chinese specialty fermented food “Jiangshui” and proved to be highly resistant to Helicobacter pylori (p < 0.0001). In vitro results showed that Q21, Q25 and QA85 strongly inhibited H. pylori and could specifically co-aggregate H. pylori in vitro (more than 56%). Strains have the potential to adhere to cells and hinder H. pylori colonization (p < 0.0001). To assess the anti-H. pylori efficacy of strains in vivo, volunteers were recruited and a self-controlled study of probiotic intervention was conducted. Compared to pre-probiotics, volunteers who took Q21, Q25 and QA85 for 1 month showed significant improvement in discomfort, a significant reduction in GSRS scores (p < 0.05), and modulation of inflammatory response (p < 0.05). Q21, Q25 and QA85 resulted in a decreasing trend of H. pylori load in volunteers (454.30 ± 327.00 vs. 328.35 ± 237.19, p = 0.06). However, the strains were not significantly effective in modulating the imbalance of the gut microbiota caused by H. pylori infection. In addition, strains affect metabolic pathways by increasing the levels of O-Phosphoethanolamine and other related metabolites, which may ameliorate associated symptoms. Therefore, Lactobacillus plantarum Q21, Q25 and QA85 can be regarded as a candidate probiotic preparation that exerts direct or indirect anti-H. pylori effects by inhibiting H. pylori activity and colonization, reducing inflammation and discomfort, maintaining homeostasis in the internal environment, affecting the metabolic pathways and repairing the body barrier. They can play a role in relieving H. pylori infection.

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Effects of Bismuth Exposure on the Human Kidney—A Systematic Review

Cited by 10 publications

References 95 publications

Helicobacter pylori Eradication Therapy in Patients with Decreased Renal Function: A Systematic Review

Helicobacter pylori Eradication Therapy in Patients with Decreased Renal Function: A Systematic Review

Bioactive Bismuth Compounds: Is Their Toxicity a Barrier to Therapeutic Use?

Screening Probiotics for Anti-Helicobacter pylori and Investigating the Effect of Probiotics on Patients with Helicobacter pylori Infection

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