Bacteriostatic and bactericidal activity of ranitidine bismuth citrate in Helicobacter pylori clinical isolates

Ranitidine bismuth citrate is a novel salt that seems to be useful in eradication of Helicobacter pylori from gastric mucosa when it is combined with antibiotics. The in vitro bacteriostatic (by MIC determination) and bactericidal (by killing curve) activity of ranitidine bismuth citrate was determined in this study. A total of 52 strains were cultured from gastric antral biopsy specimens taken at routine endoscopy and identified using standard methodology. MIC was determined by agar dilution using Mueller-Hinton agar supplemented with 7% horse blood. Killing curves were studied in 11 isolates. Ranitidine bismuth citrate at final concentrations of 1 mg/l and 8 mg/l were used. A starting inoculum of 10(4) to 10(6) CFU/ml was prepared in BHI with 10% fetal calf serum from a 48 h H. pylori broth culture. Viable colony counting was performed at 0, 2, 4, 6, 8 and 24 h. A control without the study drug was included in each experiment and treated identically. A reduction of 100 to 1,000 CFU/ml was considered bactericidal. The MIC50, MIC90 and range for ranitidine bismuth citrate was 1, 2 and 0.25-4 mg/l, respectively. At 1 mg/l it showed a bactericidal effect after 2 h in one strain, after 8 h in two and after 24 h in four strains, and four strains were not killed. At 8 mg/l it killed three strains in 2 h, one in 4 h, two in 6 h, one in 8 h and four strains in 24 h. Ranitidine bismuth citrate was active in vitro against the H. pylori clinical isolates tested (by MIC and killing curves).