‘Rescue’ Therapy with Rifabutin after Multiple Helicobacter pylori Treatment Failures

Abstract

Rifabutin-based rescue therapy constitutes an encouraging strategy after multiple previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole and tetracycline.

“Rescue” regimens after Helicobacter pylori treatment failure

“…Therefore, the position in the case of therapy failure would be clear: do not readminister any of the antibiotics against which H pylori has probably become resistant [1,49] . (9) Finally, relatively high eradication rates have been obtained with empirical third-line treatment after two consecutive failures in several studies [76,[144][145][146][147][148][149][150][151][152][153][154][155][156] . H owe ve r, l i m i t e d e x p e r i e n c e s u g g e s t s t h a t endoscopy with culture and susceptibility testing may be appropriate after failure of two eradication therapies; in this situation, a non-randomized retrospective study suggests that third-line therapy directed by the results of sensitivity testing improve eradication compared to further empirical antibiotics, demonstrating that the success rate of sensitivity-directed therapy is superior to PPI-amoxicillin-rifabutin triple therapy, and therefore suggesting that endoscopy and sensitivity testing at this point may be worthwhile rather than more widespread use of rifabutin-based regimens [72] .…”

“…Thus, until now, no rifabutin resistant strain has been isolated from patients who were either treated or untreated for H pylori infection [166] . As summarized Table 2, rifabutin-based rescue therapy constitutes an encouraging strategy after multiple previous eradication failures [63,72,130,149,[151][152][153]155,[169][170][171][172] . As an example, Perri et al [151,173] used a 1-wk regimen of PPI, amoxicillin and rifabutin in patients who were still H pylori infected after two or more courses of PPI-based triple therapies, and achieved an eradication rate of 71% by intention-to-treat analysis.…”

“…As an example, Perri et al [151,173] used a 1-wk regimen of PPI, amoxicillin and rifabutin in patients who were still H pylori infected after two or more courses of PPI-based triple therapies, and achieved an eradication rate of 71% by intention-to-treat analysis. Gisbert et al [149] , in a prospective multicenter study, included patients in whom a first eradication trial with PPI, clarithromycin and amoxicil- [151] 41…”

“…Secondly, severe leucopenia and thrombocytopenia have been reported in one patient treated with rifabutin, with myelotoxicity demonstrated by bone marrow aspirate [153] . Although blood cell count returned to normal at day 15 after discontinuation of therapy, physicians should be aware of the risk of major side-effects arising during a rifabutin-based regimen [149,155] . Finally, there is some concern about wide-spread use of rifabutin, a member of a class of established antimycobacterial drugs, in patients with H pylori infection.…”

Review: Second-line rescue therapy of Helicobacter pylori infection

“…Therefore, the position in the case of therapy failure would be clear: do not readminister any of the antibiotics against which H. pylori has probably become resistant [Howden and Hunt, 1998;Lam and Talley, 1998]. (9) Finally, relatively high eradication rates have been obtained with empirical third-line treatment after two consecutive failures in several studies [Gisbert et al 2008b[Gisbert et al , 2006a[Gisbert et al , 2006b[Gisbert et al , 2004[Gisbert et al , 2003 However, limited experience suggests that endoscopy with culture and susceptibility testing may be appropriate after failure of two eradication therapies; in this situation, a nonrandomized retrospective study suggests that third-line therapy directed by the results of sensitivity testing improve eradication compared to further empirical antibiotics, demonstrating that the success rate of sensitivity-directed therapy is superior to PPI-amoxicillin-rifabutin triple therapy, and therefore suggesting that endoscopy and sensitivity testing at this point may be worthwhile rather than more widespread use of rifabutin-based regimens [Beales, 2001]. Cammarota et al…”