Giulia Fiorini1, Angelo Zullo2, Nimish Vakil3, Ilaria M Saracino1, Chiara Ricci4, Valentina Castelli1, Luigi Gatta5, Dino Vaira1. 1. Department of Medical and Surgical Sciences, University of Bologna, Bologna. 2. Gastroenterology and Digestive Endoscopy, 'Nuovo Regina Margherita' Hospital, Rome. 3. Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI. 4. Gastroenterology Unit, University of Brescia, Brescia. 5. Gastroenterology and Endoscopy Unit, Versilia Hospital, Lido di Camaiore, Italy.
Abstract
INTRODUCTION: Eradicating Helicobacter pylori continues to be a challenge, and no treatment regimen is uniformly successful in all treated patients. Triple therapy with rifabutin and amoxicillin is a successful rescue therapy after consecutive treatment failures. We designed this study to test the efficacy of 12-day rifabutin-based triple therapy in patients infected with multidrug-resistant strains. METHODS: Consecutive patients with dyspeptic symptoms after at least 1 antibiotic therapy course for H. pylori infection harboring triple-resistant (clarithromycin, metronidazole, levofloxacin) strains were enrolled. They received triple therapy with esomeprazole 40 mg bid, amoxicillin 1 g bid, and rifabutin 150 mg od for 12 days. Patients who failed rifabutin therapy were treated empirically on the basis of the judgment of the treating physician. RESULTS: A total of 254 out of 756 tested patients were found to be infected with a triple-resistant H. pylori strains after at least 1 antibiotic therapy course. Overall, the infection was eradicated in 213 patients, corresponding to a cure rate of 82.9% (95% CI, 78.3-87.5) by intention-to-treat analysis and 88.7% (95% CI, 84.7-92.7) at per-protocol analysis. In multivariate analysis, no factor was identified as an independent predictor of bacterial eradication. CONCLUSIONS: There is no current standard for the growing population of patients with multidrug-resistant strains of H. pylori. The 12-day low-dose rifabutin/high-dose proton pump inhibitor regimen is a safe and reliable option for patients infected with triple-resistant strains.
INTRODUCTION: Eradicating Helicobacter pylori continues to be a challenge, and no treatment regimen is uniformly successful in all treated patients. Triple therapy with rifabutin and amoxicillin is a successful rescue therapy after consecutive treatment failures. We designed this study to test the efficacy of 12-day rifabutin-based triple therapy in patients infected with multidrug-resistant strains. METHODS: Consecutive patients with dyspeptic symptoms after at least 1 antibiotic therapy course for H. pyloriinfection harboring triple-resistant (clarithromycin, metronidazole, levofloxacin) strains were enrolled. They received triple therapy with esomeprazole 40 mg bid, amoxicillin 1 g bid, and rifabutin 150 mg od for 12 days. Patients who failed rifabutin therapy were treated empirically on the basis of the judgment of the treating physician. RESULTS: A total of 254 out of 756 tested patients were found to be infected with a triple-resistant H. pylori strains after at least 1 antibiotic therapy course. Overall, the infection was eradicated in 213 patients, corresponding to a cure rate of 82.9% (95% CI, 78.3-87.5) by intention-to-treat analysis and 88.7% (95% CI, 84.7-92.7) at per-protocol analysis. In multivariate analysis, no factor was identified as an independent predictor of bacterial eradication. CONCLUSIONS: There is no current standard for the growing population of patients with multidrug-resistant strains of H. pylori. The 12-day low-dose rifabutin/high-dose proton pump inhibitor regimen is a safe and reliable option for patients infected with triple-resistant strains.
Authors: Olga P Nyssen; Dino Vaira; Ilaria Maria Saracino; Giulia Fiorini; María Caldas; Luis Bujanda; Rinaldo Pellicano; Alma Keco-Huerga; Manuel Pabón-Carrasco; Elida Oblitas Susanibar; Alfredo Di Leo; Giuseppe Losurdo; Ángeles Pérez-Aísa; Antonio Gasbarrini; Doron Boltin; Sinead Smith; Perminder Phull; Theodore Rokkas; Dominique Lamarque; Anna Cano-Català; Ignasi Puig; Francis Mégraud; Colm O'Morain; Javier P Gisbert Journal: J Clin Med Date: 2022-03-16 Impact factor: 4.241