Evaluation of antimicrobial concentrations in gastric tissues for improved H. pylori eradication

Optimizing the levels and distribution of antibacterial drugs in the gastric mucosa is crucial for achieving effective H. pylori elimination rates with quadruple therapy.

Helicobacter pylori (H. pylori) is a key cause of duodenal and gastric ulcers, along with gastric cancer. Current interventions with antimicrobial and acid-suppressing drugs are often ineffective. This study examined the effectiveness and tissue distribution of combining Furazolidone and Tetracycline to improve H. pylori elimination.

Sixty H. pylori-infected people were randomly assigned into two groups. Group A received Bismuth potassium citrate (220 mg), Omeprazole (20 mg), Amoxicillin (1000 mg), and Furazolidone (500 mg), while Group B was given Bismuth potassium citrate (220 mg), Omeprazole (20 mg), Amoxicillin (1000 mg), and Tetracycline (500 mg), all twice daily for 2 weeks. On day 14, serum, gastric juice, and tissue samples from the antrum, horn, and body were collected via gastroscopy and analyzed for antimicrobial concentrations via high-performance liquid chromatography.

In the Furazolidone-negative group, antimicrobial concentrations in the gastric antrum, body, and angle were markedly greater as opposed to the positive group (P = 0.017, 0.015, and 0.028). Furazolidone levels in gastric fluid, antrum, angle, and body were approximately 421, 82, 17, and 51 times more than in serum, respectively.

In the Tetracycline-negative group, Tetracycline concentrations in serum and gastric angle were substantially higher compared to the positive group (P = 0.036 and 0.042), and levels in the gastric horn and body were about four and six times higher than in serum. Amoxicillin concentrations were higher in Group B compared to Group A, particularly in serum, gastric juice, angle, and body (P < 0.05).

Furazolidone predominantly concentrates in gastric juice, the antrum, and the body, while Tetracycline is mainly found in serum, the gastric angle, and the body. Amoxicillin is most concentrated in serum, gastric juice, the angle, and the gastric body. Enhancing the concentration and distribution of these antibiotics in the gastric mucosa is fundamental for attaining optimal eradication rates in quadruple therapy.