title: Effect of sucralfate on antibiotic therapy for Helicobacter pylori infection in mice.
abstract: It has been documented that sucralfate, a basic aluminum salt, enhances the efficacies of antibiotics against Helicobacter pylori, resulting in eradication rates comparable to those associated with the use of proton pump inhibitors. However, its mechanism of action remains unclear. The aim of the present study was to investigate sucralfate's ability to complement antibiotic treatment of H. pylori infection in vivo. Four weeks following induced H. pylori infection, clarithromycin (CAM) and amoxicillin (AMPC) were administered orally to C57BL/6 mice for 5 days, both with and without sucralfate or lansoprazole. When sucralfate was concurrently given with CAM and AMPC at the maximum noninhibitory doses for the treatment of H. pylori infection, the bacterial clearance rates were comparable to those achieved by treatment with lansoprazole plus those antibiotics. The results of pharmacokinetic studies showed that lansoprazole delayed gastric clearance and accelerated the absorption of CAM, whereas sucralfate suppressed both gastric clearance and absorption. AMPC was undetectable in all samples. Scanning electron microscopy with a microscope to which a energy dispersive spectrometer was attached revealed that aluminum-containing aggregated substances coated the mucosa surrounding H. pylori in mice receiving sucralfate plus antibiotics, whereas the gastric surface and pits where H. pylori had attached were clearly visible in mice receiving lansoprazole plus antibiotics. The addition of sucralfate to the antibiotic suspension resulted in a more viscous mixture that bound to the H. pylori-infected mucosa and that inhibited the loss of CAM bioavailability in the acidic environment. Sucralfate delays gastric clearance of CAM and physically captures H. pylori through the creation of an adherent mucus, which leads to bacterial clearance.
authors.affiliation: Department of Infectious Diseases, Faculty of Medicine, Oita University, Oita, Japan. kwata@med.oita-u.ac.jp
authors.forename: Koichiro
authors.initials: K
authors.lastname: Watanabe
authors.forename: Kazunari
authors.initials: K
authors.lastname: Murakami
authors.forename: Ryugo
authors.initials: R
authors.lastname: Sato
authors.forename: Koji
authors.initials: K
authors.lastname: Kashimura
authors.forename: Masahiro
authors.initials: M
authors.lastname: Miura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ootsu
authors.forename: Hajime
authors.initials: H
authors.lastname: Miyajima
authors.forename: Masaru
authors.initials: M
authors.lastname: Nasu
authors.forename: Tadayoshi
authors.initials: T
authors.lastname: Okimoto
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kodama
authors.forename: Toshio
authors.initials: T
authors.lastname: Fujioka
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000658:Amoxicillin / Q000627:therapeutic use; D000818:Animals; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D019540:Area Under Curve; D002626:Chemistry, Pharmaceutical; D017291:Clarithromycin / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D005756:Gastritis / Q000188:drug therapy / Q000382:microbiology; D006207:Half-Life; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori; D006863:Hydrogen-Ion Concentration; D007074:Immunoglobulin G / Q000032:analysis; D064747:Lansoprazole; D051379:Mice; D008810:Mice, Inbred C57BL; D008855:Microscopy, Electron, Scanning; D009853:Omeprazole / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use; D010406:Penicillins / Q000627:therapeutic use; D013392:Sucralfate / Q000493:pharmacokinetics / Q000627:therapeutic use*; D014783:Viscosity
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D004338:Drug Combinations; D007074:Immunoglobulin G; D010406:Penicillins; D064747:Lansoprazole; D013392:Sucralfate; D000658:Amoxicillin; D017291:Clarithromycin; D009853:Omeprazole