Rifabutin triple therapy safe, effective in patients with multidrug-resistant strains of H. pylori
No standard currently exists for the growing number of patients with multidrug-resistant strains of Helicobacter pylori, but a recent study has shown the safety and reliability of a 12-day low-dose rifabutin/high-dose proton pump inhibitor (PPI) regimen in patients infected with triple-resistant strains.
Of the 756 patients enrolled in the study, 254 were infected with a triple-resistant H. pylori strains after at least one antibiotic therapy course. In total, 213 of the infected participants had benefitted from the therapy, corresponding to a cure rate of 82.9 percent (95 percent CI, 78.3‒87.5) by intention-to-treat analysis and 88.7 percent (84.7‒92.7) at per-protocol analysis.
Furthermore, multivariate analyses showed no factor that independently predicted bacterial eradication.
In a study involving the Korean population, researchers found that rifabutin-based high-dose PPI‒combined therapy as empirical rescue treatment was more effective than rifabutin-based standard-dose PPI‒combined therapy, as well as safe and well tolerated in third-line treatment. [Helicobacter 2014;19:455-461]
In this study that evaluated the efficacy of 12-day rifabutin-based triple therapy, the investigators enrolled consecutive patients with dyspeptic symptoms after at least one antibiotic therapy course for H. pylori infection harbouring triple-resistant (clarithromycin, metronidazole, levofloxacin) strains.
Participants received triple therapy with esomeprazole 40 mg bid, amoxicillin 1 g bid and rifabutin 150 mg od for 12 days. Those who failed rifabutin therapy were empirically treated based on the judgment of the treating physician.
“Eradicating Helicobacter pylori continues to be a challenge, and no treatment regimen is uniformly successful in all treated patients,” the investigators said. “Triple therapy with rifabutin and amoxicillin is a successful rescue therapy after consecutive treatment failures.”