In patients who failed standard eradicating treatments, a 10-day course of rifabutin with pantoprazole and amoxycillin is more effective and well tolerated than the quadruple therapy.

SUMMARYBackground Diverticular disease of the colon is a common gastrointestinal disease. Although most patients remain asymptomatic for their whole life, about 20-25% present symptoms related to 'diverticular disease'. Several randomised trials verified efficacy of a poorly absorbed antibiotic, such as rifaximin-a (rifaximin), in soothing symptoms and preventing diverticulitis.

The ideal therapy to cure Helicobacter pylori is still lacking. Currently recommended eradication treatments are based on drug combinations in which an antisecretory drug (or ranitidine bismuth citrate) is administered with two of the following: clarithromycin, nitroimidazoles, tetracycline, and amoxycillin.1 In case of treatment failure, either a second course of triple regimen or a quadruple therapy (proton-pump inhibitor plus bismuth-based triple therapy) has been proposed.2 Until now, however, these regimens have been used as second-line therapies in a few patients and seem to be less effective than when used as ®rst-line treatments. 3±9 Therefore, new alternative strategies are needed.10 Preliminary studies have shown that H. pylori is highly susceptible in vitro to rifabutin, a spiropiperidyl derivative of rifamycin-S. 11 The aim of this study was to assess the ef®cacy and tolerability of rifabutin in infected patients who failed two or more courses of standard proton pump inhibitor-based triple regimens. PATIENTS AND METHODSThis open single-centre pilot study was conducted in Italy in 1997. Patients who were still H. pylori-positive on 13 C-urea breath test after at least two courses of SUMMARY Background: The ideal treatment for patients who have failed eradication of Helicobacter pylori infection after standard proton pump inhibitor-based triple therapies has still to be determined. Although either a second course of triple therapy or a quadruple therapy (proton pump inhibitor plus bismuth-based triple therapy) has been proposed, the ef®cacy of these second-line therapies is relatively unknown. Therefore, alternative strategies are needed. Aim: To assess the ef®cacy and tolerability of rifabutin, a derivative of rifamycin-S, in patients who were still H. pylori infected after two or more courses of 1-week triple therapies. Methods: Patients were given a 1-week regimen of pantoprazole 40 mg b.d. + amoxycillin 1 g b.d. + rifa-

Current analysis provides marginal support to the assumed benefits of neoadjuvant therapies for patients with resectable cancer, and indicates a potential advantage only for a minority of those with unresectable lesions.

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There is still no ideal therapy to cure Helicobacter pylori. Very recently, the European H. pylori Study Group recommended a`package treatment' including a ®rst-line triple therapy with proton pump inhibitor, amoxicillin (AMO) and clarithromycin (CLA), and, in the event of an eradication failure, a second-line quadruple therapy with proton pump inhibitor, bismuth, metronidazole (MTZ) and tetracycline.1 Although several controlled clinical trials have shown that standard triple therapies are effective in most patients, a signi®cant proportion of patients fails to eradicate the bacterium. The relevance of treatment failure is increasing worldwide as more and more people are treated for H. pylori infection. In a recent meta-analysis, triple therapy consisting of proton pump inhibitor plus two antibiotics achieved a pooled eradication rate of 90% with 95% con®dence intervals (CI) ranging from 81% to 100%. This means that up to 20% of patients are expected to fail therapies in clinical trials; this value could be even higher in clinical practice.

The UBT is an accurate non-invasive diagnostic tool and can be used to predict both the intragastric bacterial load and the severity of related gastritis.

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