title: In vitro activity of fosfomycin alone and in combination with amoxicillin, clarithromycin and metronidazole against Helicobacter pylori compared with combined clarithromycin and metronidazole.
abstract: In order to evaluate the suitability of fosfomycin in combination with other agents for the treatment of Helicobacter pylori infections, the susceptibility profiles of 65 H. pylori strains were determined against multiple antimicrobial agents and combinations thereof using the agar dilution method. For fosfomycin alone, the range of minimum inhibitory concentration (MIC) results and the MICs at which 50% and 90% of strains were inhibited were 0.5-32 microg/ml and 2 and 4 microg/ml, respectively. For the combination of fosfomycin with amoxicillin, clarithromycin or metronidazole, the means calculated for the minimum and maximum fractional inhibitory concentration index were 0.70-1.17 and 1.15-2.03, respectively, suggesting partial synergy or indifference in the majority of strains. The combination of clarithromycin and metronidazole showed synergistic activity against 14 of 28 H. pylori strains tested. The in vitro activity results suggest the combination of fosfomycin with either amoxicillin or clarithromycin may be a promising alternative for the treatment of H. pylori infection. However, the clinical efficacy of these regimens remains to be investigated.
authors.affiliation: Department of Hygiene and Medical Microbiology, Division of Hospital Hygiene, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. alexander.blacky@meduniwien.ac.at
authors.forename: A
authors.initials: A
authors.lastname: Blacky
authors.forename: A
authors.initials: A
authors.lastname: Makristathis
authors.forename: P
authors.initials: P
authors.lastname: Apfalter
authors.forename: B
authors.initials: B
authors.lastname: Willinger
authors.forename: M L
authors.initials: ML
authors.lastname: Rotter
authors.forename: A M
authors.initials: AM
authors.lastname: Hirschl
mesh_terms: D000658:Amoxicillin / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D017291:Clarithromycin / Q000494:pharmacology; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005578:Fosfomycin / Q000494:pharmacology*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D008795:Metronidazole / Q000494:pharmacology; D008826:Microbial Sensitivity Tests
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D005578:Fosfomycin; D000658:Amoxicillin; D017291:Clarithromycin