Skip to main content
PMC home page
Antimicrobial Agents and Chemotherapy logoLink to Antimicrobial Agents and Chemotherapy
. 1995 Sep;39(9):2084–2087. doi: 10.1128/aac.39.9.2084

Reduced amoxicillin uptake into human gastric mucosa when gastric juice pH is high.

G Cardaci 1, J R Lambert 1, R G King 1, N Onishi 1, P Midolo 1
PMCID: PMC162885  PMID: 8540720

Abstract

Amoxicillin when administered with gastric acid suppressors has been shown to be effective in eradication of Helicobacter pylori in 50 to 80% of subjects. The aim of this investigator-blind crossover study was to determine if gastric mucosal amoxicillin uptake was affected by increasing gastric juice pH. Fifteen male subjects (7 H. pylori positive and 8 H. pylori negative) were randomized to receive 150 mg of ranitidine twice a day, 300 mg of ranitidine twice a day, or no drug for 2 days prior to upper endoscopy. The last dose of ranitidine was given 60 min prior to upper endoscopy, and amoxicillin (500 mg) was given 30 min prior to upper endoscopy. The amoxicillin concentrations in mucosal biopsy samples, gastric juice, and serum were determined by a standard microbiological bioassay technique. Mean amoxicillin levels were greater in samples of antrum, fundus, and duodenum for volunteers who received no ranitidine than in those receiving 300 mg of ranitidine (P < 0.05) and those receiving 150 mg of ranitidine (P < 0.05 except for fundus). Amoxicillin levels in the antrum, fundus, and duodenum were negatively correlated with gastric juice pH (P < 0.005 for antrum; P < 0.001 for fundus and duodenum). There was no correlation between gastric juice pH and amoxicillin levels in either gastric juice or serum. The amoxicillin concentration in gastric juice was significantly higher with 300 mg of ranitidine than with no ranitidine (P < 0.05). Thus, lower gastric juice pH is associated with a higher rate of mucosal uptake of amoxicillin.

Full Text

The Full Text of this article is available as a PDF (181.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barza M., Weinstein L. Pharmacokinetics of the penicillins in man. Clin Pharmacokinet. 1976;1(4):297–308. doi: 10.2165/00003088-197601040-00004. [DOI] [PubMed] [Google Scholar]
  2. Bradford M. M. A rapid and sensitive method for the quantitation of microgram quantities of protein utilizing the principle of protein-dye binding. Anal Biochem. 1976 May 7;72:248–254. doi: 10.1006/abio.1976.9999. [DOI] [PubMed] [Google Scholar]
  3. Carley N. H., Wadsworth S. J., Starr E., Truant A. L., Suh B. In-vitro susceptibility of Campylobacter pylori to quinolones. J Antimicrob Chemother. 1989 Aug;24(2):266–268. doi: 10.1093/jac/24.2.266. [DOI] [PubMed] [Google Scholar]
  4. Cooreman M. P., Krausgrill P., Hengels K. J. Local gastric and serum amoxicillin concentrations after different oral application forms. Antimicrob Agents Chemother. 1993 Jul;37(7):1506–1509. doi: 10.1128/aac.37.7.1506. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Dooley C. P., Cohen H. The clinical significance of Campylobacter pylori. Ann Intern Med. 1988 Jan;108(1):70–79. doi: 10.7326/0003-4819-108-1-70. [DOI] [PubMed] [Google Scholar]
  6. Hazell S. L., Lee A., Brady L., Hennessy W. Campylobacter pyloridis and gastritis: association with intercellular spaces and adaptation to an environment of mucus as important factors in colonization of the gastric epithelium. J Infect Dis. 1986 Apr;153(4):658–663. doi: 10.1093/infdis/153.4.658. [DOI] [PubMed] [Google Scholar]
  7. Hentschel E., Brandstätter G., Dragosics B., Hirschl A. M., Nemec H., Schütze K., Taufer M., Wurzer H. Effect of ranitidine and amoxicillin plus metronidazole on the eradication of Helicobacter pylori and the recurrence of duodenal ulcer. N Engl J Med. 1993 Feb 4;328(5):308–312. doi: 10.1056/NEJM199302043280503. [DOI] [PubMed] [Google Scholar]
  8. Lambert T., Mégraud F., Gerbaud G., Courvalin P. Susceptibility of Campylobacter pyloridis to 20 antimicrobial agents. Antimicrob Agents Chemother. 1986 Sep;30(3):510–511. doi: 10.1128/aac.30.3.510. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Lin S. K., Lambert J. R., Schembri M., Nicholson L., Finlay M., Wong C., Coulepis A. A comparison of diagnostic tests to determine Helicobacter pylori infection. J Gastroenterol Hepatol. 1992 Mar-Apr;7(2):203–209. doi: 10.1111/j.1440-1746.1992.tb00963.x. [DOI] [PubMed] [Google Scholar]
  10. Marshall B. J., McGechie D. B., Rogers P. A., Glancy R. J. Pyloric Campylobacter infection and gastroduodenal disease. Med J Aust. 1985 Apr 15;142(8):439–444. doi: 10.5694/j.1326-5377.1985.tb113444.x. [DOI] [PubMed] [Google Scholar]
  11. McNulty C. A., Dent J. C., Ford G. A., Wilkinson S. P. Inhibitory antimicrobial concentrations against Campylobacter pylori in gastric mucosa. J Antimicrob Chemother. 1988 Nov;22(5):729–738. doi: 10.1093/jac/22.5.729. [DOI] [PubMed] [Google Scholar]
  12. Megraud F., Trimoulet pascale, Lamouliatte H., Boyanova L. Bactericidal effect of amoxicillin on Helicobacter pylori in an in vitro model using epithelial cells. Antimicrob Agents Chemother. 1991 May;35(5):869–872. doi: 10.1128/aac.35.5.869. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Rauws E. A., Langenberg W., Houthoff H. J., Zanen H. C., Tytgat G. N. Campylobacter pyloridis-associated chronic active antral gastritis. A prospective study of its prevalence and the effects of antibacterial and antiulcer treatment. Gastroenterology. 1988 Jan;94(1):33–40. [PubMed] [Google Scholar]
  14. Suerbaum S., Leying H., Klemm K., Opferkuch W. Antibacterial activity of pantoprazole and omeprazole against Helicobacter pylori. Eur J Clin Microbiol Infect Dis. 1991 Feb;10(2):92–93. doi: 10.1007/BF01964416. [DOI] [PubMed] [Google Scholar]
  15. Tsuji A., Nakashima E., Hamano S., Yamana T. Physicochemical properties of amphoteric beta-lactam antibiotics I: Stability, solubility, and dissolution behavior of amino penicillins as a function of pH. J Pharm Sci. 1978 Aug;67(8):1059–1066. doi: 10.1002/jps.2600670810. [DOI] [PubMed] [Google Scholar]
  16. Tytgat G. N. Helicobacter pylori: causal agent in peptic ulcer disease? Conclusion. J Gastroenterol Hepatol. 1991 Mar-Apr;6(2):139–140. doi: 10.1111/j.1440-1746.1991.tb01453.x. [DOI] [PubMed] [Google Scholar]
  17. Weil J., Bell G. D., Powell K., Morden A., Harrison G., Gant P. W., Jones P. H., Trowell J. E. Omeprazole and Helicobacter pylori: temporary suppression rather than true eradication. Aliment Pharmacol Ther. 1991 Jun;5(3):309–313. doi: 10.1111/j.1365-2036.1991.tb00032.x. [DOI] [PubMed] [Google Scholar]
  18. Westblom T. U., Duriex D. E. Enhancement of antibiotic concentrations in gastric mucosa by H2-receptor antagonist. Implications for treatment of Helicobacter pylori infections. Dig Dis Sci. 1991 Jan;36(1):25–28. doi: 10.1007/BF01300082. [DOI] [PubMed] [Google Scholar]

Articles from Antimicrobial Agents and Chemotherapy are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES