How Did We End Up Using a Quadruple Guided Therapy Combining At Least Two Antibiotics with a PPI to Eradicate Helicobacter pylori?

Pichon, Maxime; Cremniter, Julie; Burucoa, Christophe

doi:10.3390/jcm11175216

Cited by 2 publications

(2 citation statements)

References 15 publications

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“…Helicobacter pylori peptic ulcers may be treated with one of less than ten medications, including metronidazole, amoxicillin, clarithromycin, furazolidone, levofloxacin, and tetracycline. Antimicrobial resistance may be avoided and effective eradication is achieved by combining these antibiotics with bismuth salts and proton pump inhibitors (PPIs) [ 1 , 2 ]. The World Health Organisation has designated the study and development of novel medicines for H. pylori species that are resistant to clarithromycin as a "high priority'' [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Rifabutin-Based Regimens in Treating Helicobacter pylori Infections

Gugnani,

Abhishek,

Agarwal

et al. 2023

Cureus

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Helicobacter pylori has been reported as a health problem worldwide, affecting a sizable portion of people. Peptic ulcers, gastric cancer, and various extra gastric conditions are associated with this bacterium. The rampant overprescribing of antibiotics has led to the emergence of H. pylori strains resistant to multiple antibiotics, causing a decline in the effectiveness of current treatments. Recently, there has been growing interest in researching alternative treatment options for H. pylori infections that do not respond to initial therapy. Rifabutin, a rifamycin derivative initially designed for tuberculosis treatment and preventing Mycobacterium avium complex infection, has gained attention as a potential rescue medication. It has shown efficacy against H. pylori and the potential to eradicate the bacterium when combined with other antibiotics. This systematic review article focuses on using rifabutin-based regimens as a treatment option after initial treatments have failed. The authors screened literature published in the last five years, between 2017 and 2022, across various search engines and closely examined relevant studies following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The search covered a variety of electronic databases and focused on H. pylori gastritis, rifabutin-based treatment plans, and in vivo investigations in healthy individuals. The comprehensive review provides convincing evidence that rifabutin-based regimens are effective rescue treatments for H. pylori infections. Multiple studies in various areas consistently demonstrated high eradication rates, ranging from 70% to 90%, when rifabutin-containing regimens were used. The analysis found that only a tiny percentage of H. pylori strains (1%) were resistant to rifabutin therapy, further supporting the viability of Rifabutin as an alternative when other antibiotics failed to eradicate H. pylori. The cost of Rifabutin is a significant factor that may limit its accessibility, particularly in resource-constrained settings where H. pylori infection is common. Moreover, the potential side effects of Rifabutin, such as hematological problems, rashes, and digestive issues, need to be considered. However, these side effects are typically manageable and can be reduced by combining Rifabutin with other antibiotics. In conclusion, this systematic review provides evidence supporting the effectiveness of regimens derived from Rifabutin in eliminating H. pylori infections after initial therapy failure. Due to the observation that Rifabutin effectively eradicates resistant H. pylori infections, it can be considered a suitable choice for rescue therapy. Rifabutin-containing regimens should be reserved as fourth- or later-line therapy options, considering economic factors, the risk of microbial resistance, potential side effects, and the availability of alternative medications. Future research should focus on optimizing rifabutin-based regimens and investigating combination therapies that have better H....

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Section: Introductionmentioning

confidence: 99%

Effectiveness of Rifabutin-Based Regimens in Treating Helicobacter pylori Infections

Gugnani,

Abhishek,

Agarwal

et al. 2023

Cureus

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“…10 H. pylori infection is unique in the need for optimised local gastric action of antibiotics. In fact, Pichon et al 11 described the importance of the rate of administration, the antibiotic concentration at the gastric mucosa, and the use of pharmacokinetic/pharmacodynamic (PKPD) models to optimise H. pylori treatment.…”

Section: Introductionmentioning

confidence: 99%

Physiologically‐based pharmacokinetic modelling to predict intragastric rifabutin concentrations in the treatment of Helicobacter pylori infection

Howden

Shah

Pendse³

et al. 2023

Aliment Pharmacol Ther

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Summary Background Sustained intragastric antibiotic exposure is important for Helicobacter pylori eradication, yet little is known about gastric pharmacology of commonly used H. pylori regimens. For rifabutin, differing intragastric concentrations based on dosing regimen may account for differences in reported eradication rates. Aim To compare intragastric rifabutin concentrations between low‐dose rifabutin (50 mg three time daily; as in RHB‐105) and generically dosed rifabutin 150 mg once daily, 150 mg twice daily, and 300 mg once daily using a validated Physiologically‐based pharmacokinetic (PBPK) model. Methods We obtained plasma pharmacokinetic data from the RHB‐105 clinical development programs and used it to develop and validate a whole‐body PBPK model using PK‐SIM software. We modified the existing rifabutin model to include the impact of omeprazole on gastric pH and emptying time. Modelled intragastric rifabutin exposure was expressed as the time that each regimen maintained its concentration ≥MIC90. Results Rifabutin 50 mg three times daily achieved significantly longer times with intragastric concentration above MIC90 (22.3 ± 1.1 h) than 150 mg once daily (8.3 ± 1.7 h), 150 mg twice daily (16.3 ± 2.3 h), or 300 mg once daily (8.5 ± 1.9 h) while providing the lowest mean maximal plasma concentration and mean area under the plasma concentration–time curve of all regimens studied. Conclusions PBPK modelling showed rifabutin 50 mg three times daily had higher intragastric exposure times than 150 mg once daily or twice daily, or 300 mg once daily. This low‐dose rifabutin regimen provides the highest potential for H. pylori eradication while minimising systemic rifabutin exposure.

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How Did We End Up Using a Quadruple Guided Therapy Combining At Least Two Antibiotics with a PPI to Eradicate Helicobacter pylori?

Cited by 2 publications

References 15 publications

Effectiveness of Rifabutin-Based Regimens in Treating Helicobacter pylori Infections

Effectiveness of Rifabutin-Based Regimens in Treating Helicobacter pylori Infections

Physiologically‐based pharmacokinetic modelling to predict intragastric rifabutin concentrations in the treatment of Helicobacter pylori infection

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