Abstract
Background: Increased prevalence of antibiotic resistance to Helicobacter pylori (H. pylori) infection worldwide has driven the search for a new therapeutic candidate. Recently, sitafloxacin, a novel 4-quinolone agent, has emerged as a new therapeutic option for H. pylori eradication, in Japan. However, data on its efficacy for H. pylori eradication in Korea are limited. Therefore, we aimed to investigate the therapeutic potential of sitafloxacin as a first-line treatment for patients with Helicobacter infection through gastric tissue culture-based studies. Materials and Methods: We prospectively enrolled treatment-naïve patients with H. pylori infection who visited the Gil Medical Center between March 2015 and March 2018. After obtaining written informed consent from patients, a total of 121 H. pylori strains were collected. We tested the susceptibility of these strains to sitafloxacin, and other antibiotics for Helicobacter eradication, including clarithromycin (CLR), metronidazole (MTZ), amoxicillin (AMX), tetracycline (TET), levofloxacin (LEV), and ciprofloxacin (CIP) using the agar dilution technique. The minimum inhibitory concentration (MIC) of these antibiotics against H. pylori strains were determined. Results: None of the H. pylori strains obtained were resistant to sitafloxacin (MIC > 1, n = 0), while other conventional eradication drugs including CLR, MTZ, AMX, and TET showed 24.8% (n = 30), 30.6% (n = 37), 5.0% (n = 6), and 0.8% (n = 1) resistance, respectively. Compared to the resistance rates of other quinolones (LEV [36.4%, n = 44] and CIP [37.2%, n = 45]), sitafloxacin showed the best antibiotic performance against Helicobacter strains (0%, n = 0). Furthermore, sitafloxacin also inhibited the growth of 14 H. pylori strains (12.4%), which were resistant to both of clarithromycin, and metronidazole, and 27 strains (22.3%) with multidrug resistance. Conclusions: Sitafloxacin might be a new promising candidate for Helicobacter eradication where antibiotic resistance for Helicobacter is an emerging medical burden, such as in Korea.
Highlights
Fluoroquinolone, a component of the second-line or rescue regimen for drug-resistant H. pylori, has been gaining resistance to H. pylori infection according to a 10-year trend analysis, from a 12% prevalence in 2006–2008 to 31%
Of the 121 H. pylori strains, none were resistant to sitafloxacin (MIC > 1, n = 0), whereas other conventional drugs used for eradication, including CLR, MTZ, AMX, and TET, showed resistance rates of 24.8% (n = 30), 30.6% (n = 37), 5.0% (n = 6), and 0.8% (n = 1), respectively (Table 2)
We investigated the in vitro activity of sitafloxacin, a new-generation quinolone drug, in the treatment of H. pylori infection through gastric tissue culture-based quinolone drug, in the treatment of H. pylori infection through gastric tissue culstudies using H. pylori strains obtained from 121 patients with H. pylori infection in Korea
Summary
The antibiotic resistance associated with Helicobacter pylori (H. pylori) infections has increased worldwide, leading to a global medical burden [1,2]. Concerns regarding multidrug resistant (MDR) Helicobacter infections have been increasing [3]. Recent reviews regarding the status of MDR H. pylori worldwide showed that, even though it varied among and within nations, the pooled prevalence of H. pylori primary resistance to clarithromycin and metronidazole was up to 32% and 38%, respectively, in Europe [3,4,5], and 27%, and. 59%, respectively, in Southeast Asia [3,5]. Fluoroquinolone, a component of the second-line or rescue regimen for drug-resistant H. pylori, has been gaining resistance to H. pylori infection according to a 10-year trend analysis, from a 12% prevalence in 2006–2008 to 31%
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