Drug interaction-PPI+Colloidal Bismuth Subcitrat+Tetracyclin

[Asim]

While going through the internet i had come across a an article on 2nd line of threapy with PPIs +Colloidal Bismuth Subcitrate (CBS)+Tetracycline+meterodizole, wherein it was stated that 30 mins before or after administration of Colloidal Bismuth Subcitrate no drug to be taken, further it stated that PPIs can change the way Colloidal Bismuth Subcitrate works on the stomach lining hence a gap of 30 mins to be observed between PPIs & Colloidal Bismuth Subcitrate and it is no secret that PPIs reduces the absorbtion of Tetracycline in the human stmoach by 50 to 90% !.

My question is if somebody has to take the above combination how he or she should plan his/her dosages? can all the 4 (PPIs+Colloidal Bismuth Subcitrate (CBS)+Tetracycline+meterodizole ) taken together or PPIs should be taken after a gap of 30 mins from Colloidal Bismuth Subcitrate administration and Tetracycline+meterodizole should be taken another 30 mins after the PPIs administration i.e 1 hour after the administration of Colloidal Bismuth Subcitrate . In a nut shell what is the best way to take these 4 medicines (in terms of time interval so that they are highly active in the eradication of H.Pylori).

By the way my Gastro says PPIs+Tetracycline+meterodizole can be taken after 30 mins from the time of administration of Colloidal Bismuth Subcitrate . but if i follow this then i risk non-absorbtion of Tetracycline by 50 to 90% ! hence maybe less chance of eradication of H Pylori. I have already failed the 1st line of standard threapy with Amoxicilin and clarithromycin.Pls guide. Thnks

[rifle_li]

I think the best way is : 1-PPI, 2-Bismuth, 3-Tetracyclin. My doctor told me that PPI+Bismuth 30mins before meal, and antibiotics after meal, twice a day.

[barjammar]

All this theory is unnecessary because the bismuth and tetracycline therapy acts in the stomach - so no need to be fussy about absorption. Dr Dore and Graham even gave just a double dose twice daily with meals = all together - and cure rate was perfectly ok.
I attached a reference below as a picture. You can probably find the article on-line.

[rifle_li]

Thank you, Mr. Barjammar. Your answer is very useful.