Rifabutin-based Triple Therapy After Failure of Helicobacter pylori Eradication Treatment

Abstract

Despite continuous improvement of Helicobacter pylori (Hp) eradication therapy, new treatment regimens are necessary if established first-line treatments fail. In the present pilot study, a recently described rifabutin-based triple therapy was evaluated after preceding failure of triple therapy. Rifabutin (150 mg), amoxicillin (1 g), and lansoprazole (30 mg) were administered twice daily for 1 week to 25 patients infected with Hp who had previously failed to respond to eradication treatment and/or who had developed resistance to macrolides and nitroimidazoles. Four patients were lost to follow-up. Eradication rate of rifabutin-based triple therapy was 86% (18/21; per protocol) and 72% (18/25; intention-to-treat). Side effects were minimal. It is concluded that this new drug combination is an effective therapy for Hp strains resistant to clarithromycin or metronidazole; however, rifabutin-based treatment regimens for Hp eradication should be restricted to patients infected with resistant strains.

“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.…”

“…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. Because multiresistant strains of Mycobacterium tuberculosis increase in numbers, indications for these drugs should be chosen very carefully to avoid further acceleration of development of resistance [152] . At present, therefore, rifabutin should be considered only as the last option (e.g.…”

Comparison of 7- and 14-day first-line therapies including levofloxacin in patients with Helicobacter pylori positive non-ulcer dyspepsia

“…Fluoroquinolones, rifabutin and newer macrolides have been used with variable rates of success (11)(12)(13). Levofloxacin is an isomer of ofloxacin with a broad spectrum of activity against several Gram-positive and Gramnegative bacteria and atypical respiratory pathogens (14-16).…”

Trend for Treatment ofHelicobacter pyloriin Overseas Country

“…Rifabutin은 구제 치료(salvage 치료)로 많이 이용되고 있고 제균율은 50∼100% 로 다양하게 보고하고 있다 (Table 6). [65][66][67][68][69][70] 다른 치료에 여러 차 례 실패한 후 이용되었을 때 제균율이 68%인데 반해 rifabutin 포함 제균 치료는 2차 치료로 이용되었을 때 95%로 제균율이 높게 나와 2차 치료 때 가장 효과적인 것으로 보여진다. 71,72 Rifabutin은 항생제 민감도 검사에서 H. pylori에 대한 내성으 …”