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In this study, we evaluated the effect of proton pump inhibitors (PPIs) on  in vitro  antimicrobial activity of tigecycline against several species of clinical pathogens. Clinical non-duplicate isolates of  Acinetobacter baumannii ,  Staphylococcus aureus ,  Enterococcus faecalis  and three species of  Enterobacteriaceae  ( Escherichia coli ,  Klebsiella pneumonia  and  Enterobacter cloacae ) were collected from a tertiary hospital and their MICs of tigecycline alone and in combination with PPIs (omeprazole, lansoprazole and pantoprazole) were determined. With one randomly selected isolate of each bacterial species, an  in vitro  time–kill study was performed for the confirmation of the effect of PPIs on tigecycline activity. The MIC changes after PPIs addition correlated with the PPIs concentrations in the test media. Compared with tigecycline alone, the addition of 5 mg/L PPIs could increase the MICs of tigecycline by 0 to 2-fold and the addition of 50 mg/L PPIs could increase the MICs of tigecycline by 4 to >128-fold. The time–kill study confirmed that the addition of PPIs could affect the  in vitro  activity of tigecycline. Even at low concentration (5 mg/L) of omeprazole and pantoprazole, antagonistic effect could be observed in  E. cloacae  and  E. faecalis  strains. We conclude that  In vitro  activity of tigecycline can be influenced by the presence of PPIs in a concentration-dependent manner.

Effect of Proton Pump Inhibitors on In Vitro Activity of Tigecycline against Several Common Clinical Pathogens