Rifabutin‐based ‘rescue therapy’ for Helicobacter pylori infected patients after failure of standard regimens

Abstract

The ideal therapy to cure Helicobacter pylori is still lacking. Currently recommended eradication treatments are based on drug combinations in which an antisecretory drug (or ranitidine bismuth citrate) is administered with two of the following: clarithromycin, nitroimidazoles, tetracycline, and amoxycillin.1 In case of treatment failure, either a second course of triple regimen or a quadruple therapy (proton-pump inhibitor plus bismuth-based triple therapy) has been proposed.2 Until now, however, these regimens have been used as second-line therapies in a few patients and seem to be less effective than when used as ®rst-line treatments. 3±9 Therefore, new alternative strategies are needed.10 Preliminary studies have shown that H. pylori is highly susceptible in vitro to rifabutin, a spiropiperidyl derivative of rifamycin-S. 11 The aim of this study was to assess the ef®cacy and tolerability of rifabutin in infected patients who failed two or more courses of standard proton pump inhibitor-based triple regimens. PATIENTS AND METHODSThis open single-centre pilot study was conducted in Italy in 1997. Patients who were still H. pylori-positive on 13 C-urea breath test after at least two courses of SUMMARY Background: The ideal treatment for patients who have failed eradication of Helicobacter pylori infection after standard proton pump inhibitor-based triple therapies has still to be determined. Although either a second course of triple therapy or a quadruple therapy (proton pump inhibitor plus bismuth-based triple therapy) has been proposed, the ef®cacy of these second-line therapies is relatively unknown. Therefore, alternative strategies are needed. Aim: To assess the ef®cacy and tolerability of rifabutin, a derivative of rifamycin-S, in patients who were still H. pylori infected after two or more courses of 1-week triple therapies. Methods: Patients were given a 1-week regimen of pantoprazole 40 mg b.d. + amoxycillin 1 g b.d. + rifa-

A 10‐day levofloxacin‐based triple therapy in patients who have failed two eradication courses

“…Rifabutin is an antitubercolotic compound which has been used, reaching interesting eradication rates ranging from 71 to 86.6%. 20,21 However, rifabutin is expensive, associated with mielotoxicity, 22 and, as it is a useful antimicrobial drug for tuberculosis, its widespread use should be limited to prevent developing resistance to it. Furazolidone has also been proposed but it is associated with important adverse events too.…”

“…7 Nevertheless, bacterial eradication may fall in up to 40% of cases after the suggested second-line regimens and doctors who treat this infection are often faced with a certain number of patients for whom two treatment attempts have failed. [10][11][12][13][14] Furthermore, a progression of H. pylorirelated chronic active gastritis towards atrophy, intestinal metaplasia and gastric cancer has also been reported suggesting that further attempts to cure the infection are worthwhile. 15 Currently, a standard thirdline treatment is lacking, and European guidelines recommend culture in these patients to select a thirdline treatment according to microbial sensitivity to antibiotics.…”

Rifabutin‐based Helicobacter pylori eradication ‘rescue therapy’

“…1 In order to verify rifabutin ef®cacy and tolerability, we carried out a 10-day trial with the following regimen: omeprazole (20 mg b.d. ), amoxicillin (1 g b.d.…”

The burden of Helicobacter pylori infection in Europe

“…Alternative antibiotics such as furazolidone and the anti-tuberculosis agent rifabutin have shown promising results but clinical experience is limited to date. 56 The ideal treatment for H. pylori infection should be easy to comply with, cheap, widely available, and effective. Our current treatment regimens are still quite a long way from that ideal.…”