{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T20:30:40Z","timestamp":1788813040496,"version":"build-2803163510"},"reference-count":26,"publisher":"American Society for Microbiology","issue":"11","license":[{"start":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T00:00:00Z","timestamp":1762214400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T00:00:00Z","timestamp":1762214400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2025,11,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Ilaprazole, a proton pump inhibitor, has been approved and marketed in Korea\n                        and China for the treatment of gastric ulcer, duodenal ulcer,\n                        gastroesophageal reflux disease, and erosive esophagitis. This study\n                        evaluated the\n                      <jats:italic toggle=\"yes\">in vitro<\/jats:italic>\n                      antibacterial activity of ilaprazole\n                        against\n                      <jats:italic toggle=\"yes\">Helicobacter pylori<\/jats:italic>\n                      (\n                      <jats:italic toggle=\"yes\">H. pylori<\/jats:italic>\n                      ),\n                        both as a single agent and in combination with other components used in the\n                        standard quadruple therapy. The antibacterial activity of ilaprazole was\n                        tested on 25\n                      <jats:italic toggle=\"yes\">H<\/jats:italic>\n                      .\n                      <jats:italic toggle=\"yes\">pylori<\/jats:italic>\n                      strains, including\n                        the clinical isolates resistant to clarithromycin (CLA), amoxicillin (AMX),\n                        levofloxacin, and\/or metronidazole. Antibacterial activities and killing\n                        kinetics were evaluated by the minimal inhibitory concentration (MIC) and\n                        time-kill curve determination, respectively. Synergistic effects were\n                        assessed in checkerboard and time-kill assays. Resistance development was\n                        assessed through serial passage over 12 cycles. Ilaprazole exhibited potent\n                      <jats:italic toggle=\"yes\">in vitro<\/jats:italic>\n                      antibacterial activity against\n                      <jats:italic toggle=\"yes\">H.\n                            pylori<\/jats:italic>\n                      , with MIC\n                      <jats:sub>50<\/jats:sub>\n                      and MIC\n                      <jats:sub>90<\/jats:sub>\n                      values of 8\n                        \u00b5g\/mL, demonstrating activity against drug-resistant strains. When\n                        combined with CLA, ilaprazole showed synergistic effects against 36% of the\n                        tested strains. Notably, the quadruple combination of ilaprazole + AMX + CLA\n                        + bismuth potassium citrate exhibited an obvious synergistic effect.\n                        Importantly, repeated exposure to ilaprazole over 12 passages did not induce\n                        resistance. These findings highlight the promising\n                      <jats:italic toggle=\"yes\">in vitro<\/jats:italic>\n                      antibacterial activity of ilaprazole against\n                      <jats:italic toggle=\"yes\">H. pylori<\/jats:italic>\n                      ,\n                        including drug-resistant strains, and its potential to enhance the efficacy\n                        of quadruple therapy. The study supports the inclusion of ilaprazole in\n                        treatment regimens for\n                      <jats:italic toggle=\"yes\">H. pylori<\/jats:italic>\n                      infections, offering a\n                        compelling rationale for its clinical use.\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>\n                        <jats:italic toggle=\"yes\">H. pylori<\/jats:italic>\n                        infection remains a major global health issue,\n                            contributing to a wide range of gastric diseases. Despite current\n                            treatment regimens, rising antibiotic resistance limits their\n                            effectiveness, emphasizing the need for novel therapeutic approaches.\n                            This study highlights the promising\n                        <jats:italic toggle=\"yes\">in vitro<\/jats:italic>\n                        antibacterial activity of ilaprazole against\n                        <jats:italic toggle=\"yes\">H. pylori<\/jats:italic>\n                        ,\n                            including drug-resistant strains. Ilaprazole not only exhibits direct\n                            antimicrobial effects but also enhances the efficacy of combination\n                            therapy, particularly in quadruple therapy regimens, which are\n                            recommended as first-line treatment. The findings demonstrate that\n                            ilaprazole, in combination with clarithromycin, shows synergistic\n                            effects, offering a potential solution to overcome antibiotic resistance\n                            challenges. Importantly, repeated exposure to ilaprazole did not induce\n                            resistance, a critical factor for its long-term use. These results\n                            provide compelling evidence for ilaprazole\u2019s inclusion in\n                            clinical treatment strategies, contributing to improved eradication\n                            rates and better patient outcomes in\n                        <jats:italic toggle=\"yes\">H. pylori<\/jats:italic>\n                        management.\n                      <\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.00593-25","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T13:00:37Z","timestamp":1758718837000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":1,"title":["<i>In vitro<\/i>\n                    anti-\n                    <i>Helicobacter pylori<\/i>\n                    activity of ilaprazole used alone and in combination with other components of                    quadruple 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