The effect of antibiotics and bismuth on fecal hydrogen sulfide and sulfate-reducing bacteria in the rat.

Colonic bacteria produce the highly toxic thiol, hydrogen sulfide. Despite speculation that this compound induces colonic mucosal injury, there is little information concerning manipulations that might reduce its production. We studied the effect of antibiotics and bismuth on the production of hydrogen sulfide in rats. Baseline fecal samples were analyzed for hydrogen sulfide concentration and release rate during incubation and numbers of sulfate-reducing bacteria. Groups of six rats received daily doses of ciprofloxacin, metronidazole, or sulfasalazine for one week, and feces were reanalyzed. Bismuth subnitrate was then added to the antibiotic regimens. While sulfide production and sulfate-reducing bacteria were resistant to treatment with ciprofloxacin or metronidazole, bismuth acted synergistically with ciprofloxacin to inhibit sulfate-reducing bacteria growth and to reduce sulfide production. Combination antibiotic-bismuth therapy could provide insights into the importance of sulfide and sulfate-reducing bacteria in both human and animal models of colitis and have clinical utility in the treatment of antibiotic-resistant enteric pathogens.