Abstract

BACKGROUND
In some cases, Helicobacter pylori infection persists even after three eradication treatments.
AIM
To evaluate the efficacy of an empirical fourth-line rescue regimen with rifabutin in patients with three eradication failures.
METHODS
Design: Multicentre, prospective study. Patients: In whom the following three treatments had consecutively failed: first (PPI + clarithromycin + amoxicillin); second (PPI + bismuth + tetracycline + metronidazole); third (PPI + amoxicillin + levofloxacin). Intervention: A fourth regimen with rifabutin (150 mg b.d.), amoxicillin (1 g b.d.) and a PPI (standard dose b.d.) was prescribed for 10 days. Outcome: Eradication was confirmed by (13) C-urea breath test 4-8 weeks after therapy. Compliance and tolerance: Compliance was determined through questioning and recovery of empty medication envelopes. Adverse effects were evaluated using a questionnaire.
RESULTS
One-hundred patients (mean age 50 years, 39% men, 31% peptic ulcer/69% functional dyspepsia) were included. Eight patients did not take the medication correctly (in six cases due to adverse effects). Per-protocol and intention-to-treat eradication rates were 52% (95% CI = 41-63%) and 50% (40-60%). Adverse effects were reported in 30 (30%) patients: nausea/vomiting (13 patients), asthenia/anorexia (8), abdominal pain (7), diarrhoea (5), fever (4), metallic taste (4), myalgia (4), hypertransaminasemia (2), leucopenia (<1,500 neutrophils) (2), thrombopenia (<150,000 platelets) (2), headache (1) and aphthous stomatitis (1). Myelotoxicity resolved spontaneously in all cases.
CONCLUSIONS
Even after three previous H. pylori eradication failures, an empirical fourth-line rescue treatment with rifabutin may be effective in approximately 50% of the cases. Therefore, rifabutin-based rescue therapy constitutes a valid strategy after multiple previous eradication failures with key antibiotics, such as clarithromycin, metronidazole, tetracycline and levofloxacin.

Links

Publisher Full Text

Authors

Gisbert JP, Castro-Fernandez M, Perez-Aisa A, Cosme A, Molina-Infante J, Rodrigo L, Modolell I, Cabriada JL, Gisbert JL, Lamas E, Marcos E, Calvet X

Institution

Gastroenterology Department, Hospital de La Princesa, Madrid, Spain. gisbert@meditex.es

Source

Alimentary pharmacology & therapeutics 35:8 2012 Apr pg 941-7

MeSH

Adult
Anti-Bacterial Agents
Drug Therapy, Combination
Dyspepsia
Female
Follow-Up Studies
Helicobacter Infections
Helicobacter pylori
Humans
Male
Middle Aged
Patient Compliance
Peptic Ulcer
Prospective Studies
Questionnaires
Rifabutin
Treatment Failure
Treatment Outcome

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

22372560