The pharmacodynamic properties of the ketolides HMR 3647 (telithromycin) and HMR 3004 were studied against Helicobacter pylori. Both ketolides showed a pronounced concentration-dependent killing, a significant postantibiotic effect, a long postantibiotic sub-MIC effect, and a reduction of intracellular H. pylori.Helicobacter pylori establishes persistent infection in the gastric mucosa of humans. Antimicrobial treatment of H. pylori is now widely recommended for patients with peptic ulcer who are carrying this bacterium. H. pylori has so far been considered to colonize exclusively extracellularly. There are, however, considerable data supporting an intracellular location of the bacterium in vivo (4,8). Due to the increasing problems with macrolide resistance in H. pylori (5, 9), the development of new treatment regimens, including antibiotics with intracellular activity, is needed. The aim of our study was to evaluate the pharmacodynamic properties of the ketolides HMR 3647 (telithromycin) and HMR 3004 against extracellular and intracellular H. pylori.(This work was presented at the 38th Interscience Conference on Antimicrobial Agents and Chemotherapy, San Diego, Calif., 24 to 27 September, 1998.)H. pylori NCTC 11637 was grown on chocolate agar plates (Columbia II agar base BBL; Becton Dickinson and Co., Franklin Lake, N.J.) supplemented with 10% horse serum and 8.5% horse blood. For broth cultures we used brucella broth (pH 7.3) supplemented with 10% fetal calf serum. Plates and broth cultures were incubated at 37°C in a humid atmosphere under microaerophilic conditions (7% CO 2 and 87% N 2 ). Broth cultures, incubated for 3 days, were prepared prior to the experiments. The turbidity was measured at an optical density at 530 nm of 0.5, which corresponds to 10 8 CFU/ml. HMR 3647 and HMR 3004 with known potencies were kindly provided by Hoechst Marion Roussel, Romainville, France. A stock solution was made before each experiment by dissolving 10.2 mg of the drug in 10 ml of sterile distilled water supplemented with 20 l of glacial acetic acid.MICs were determined by the macrodilution technique with an inoculum of 5 ϫ 10 5 to 1 ϫ 10 6 CFU/ml, according to NCCLS standards (11). The MIC was defined as the lowest concentration inhibiting visible growth after 3 days. To investigate whether the killing pattern was concentration dependent, bacteria at a density of 10 6 CFU/ml were exposed to 2, 5, 10, and 50 times the MIC. A growth control was also included.Samples were withdrawn after 0, 1, 2, 3, 6, 9, 12, and 24 h, and appropriate dilutions were seeded on chocolate agar in volumes of 0.1 and 0.01 ml. The plates were incubated for 5 days before the colonies were counted. The sensitivity of the viable count is estimated at 10 to 50 CFU/ml.Postantibiotic effect (PAE) and postantibiotic sub-MIC effect (PASME) determinations were performed with cultures of 10 7 CFU/ml exposed to 10 times the MIC for 2 h at 37°C. Unexposed controls were included. To eliminate the antibiotics, both cultures were washed twice with broth by ce...