Yoshihiro Hirata1,2, Atsuo Yamada1, Ryota Niikura1, Satoki Shichijo1,3, Yoku Hayakawa1, Kazuhiko Koike1. 1. Department of Gastroenterology, The University of Tokyo, Tokyo, Japan. 2. Division of Advanced Genome Medicine, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. 3. Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.
Abstract
BACKGROUND: A small proportion of Helicobacter pylori-infected individuals in Japan suffer failure of eradication therapy with third-line regimens containing the potent acid suppressor, vonoprazan, and a quinolone. OBJECTIVES: This prospective study evaluated the efficacy and safety of rifabutin-based triple therapy with vonoprazan for refractory H pylori infection. METHODS: Patients who failed H pylori eradication by clarithromycin-based first-line, metronidazole-based second-line, and sitafloxacin-based third-line therapies were recruited. After obtaining informed consent, patients received eradication therapy with vonoprazan (20 mg), amoxicillin (750 mg), and rifabutin (150 mg) twice daily for 10 days. Eradication was confirmed by a negative H pylori stool antigen or urea breath test at least 8 weeks after the end of therapy. RESULTS: Nineteen patients were included in the study. All of the patients completed the course of medication. Eradication of H pylori was confirmed in all of the patients (19/19; 100%, 95% confidence interval; 83-100%). The most common adverse event was soft stool/diarrhea (4/19, 21%). No severe adverse event was observed. CONCLUSIONS: Ten-day rifabutin with amoxicillin and vonoprazan triple therapy appears to be effective and safe for refractory H pylori infections. However, considering the recent publications showing high eradication rates with vonoprazan amoxicillin dual therapy, confirmation will require future studies comparing our new therapy with vonoprazan-amoxicillin dual with similar doses and duration and with vonoprazan-rifabutin dual therapy.
BACKGROUND: A small proportion of Helicobacter pylori-infected individuals in Japan suffer failure of eradication therapy with third-line regimens containing the potent acid suppressor, vonoprazan, and a quinolone. OBJECTIVES: This prospective study evaluated the efficacy and safety of rifabutin-based triple therapy with vonoprazan for refractory H pylori infection. METHODS:Patients who failed H pylori eradication by clarithromycin-based first-line, metronidazole-based second-line, and sitafloxacin-based third-line therapies were recruited. After obtaining informed consent, patients received eradication therapy with vonoprazan (20 mg), amoxicillin (750 mg), and rifabutin (150 mg) twice daily for 10 days. Eradication was confirmed by a negative H pylori stool antigen or urea breath test at least 8 weeks after the end of therapy. RESULTS: Nineteen patients were included in the study. All of the patients completed the course of medication. Eradication of H pylori was confirmed in all of the patients (19/19; 100%, 95% confidence interval; 83-100%). The most common adverse event was soft stool/diarrhea (4/19, 21%). No severe adverse event was observed. CONCLUSIONS: Ten-day rifabutin with amoxicillin and vonoprazan triple therapy appears to be effective and safe for refractory H pylori infections. However, considering the recent publications showing high eradication rates with vonoprazanamoxicillin dual therapy, confirmation will require future studies comparing our new therapy with vonoprazan-amoxicillin dual with similar doses and duration and with vonoprazan-rifabutin dual therapy.
Authors: Pedro Cortés; Alfred D Nelson; Yan Bi; Fernando F Stancampiano; Loren P Murray; George G A Pujalte; Victoria Gomez; Dana M Harris Journal: J Prim Care Community Health Date: 2021 Jan-Dec
Authors: Anoja W Gunaratne; Harrison Hamblin; Annabel Clancy; Aleja Jane Marie C Magat; Marie Vic M Dawson; Jeffrey Tu; Thomas J Borody Journal: Helicobacter Date: 2021-07-10 Impact factor: 5.753