Effectiveness and Safety of Rifaximin-Containing Regimens for Helicobacter pylori Eradication: Systematic Review – Are They Potential Eradication Regimens?

Abstract

Background Rifaximin, a rifamycin antibiotic, is widely used to treat infectious diarrhea but not commonly used in H. pylori eradication. With its potential advantages of the agent, some studies were conducted on this topic. The aim of this study is to assess effectiveness and safety of rifaximin-containing regimens and to evaluate whether they are alternative choices for H. pylori eradication. Methods Scientific databases including PubMed, EMbase and Cochrane Library were used to identify clinical trials on rifaximin-containing regimens published from January 2000 to October 2021. Review Manager 5.4 and STATA12 were adopted for the systematic review. Results In this study, totally 1025 patients were included from 3 randomized controlled and 9 single-arm studies. It showed that the differences in effectiveness and safety between rifaximin-containing and first-line regimens were not statistically significant in randomized controlled trials. However, the results of the single-arm trials indicated that the eradication and adverse drug reaction rate varied suggesting data instability ( r =38.1%-85.4%, r ADR 0.00–67.5% by ITT analysis). Among them, the eradication rate of pediatric patients ( r =85.4% by ITT analysis) was higher than that of adult patients ( r =38.1–74.5% by ITT analysis). Meanwhile, in all adult subgroups (triple or quadruple, with or without amoxicillin, different duration and rifaximin dose), the results did not show sufficient effectiveness as all the eradication rates did not meet the minimum ideal or ideal target. Conclusion Taken together, rifaximin-containing regimens should not be recommended for H. pylori eradication as they cannot achieve the eradication rate desired.

Clinical Implications of Helicobacter pylori Antibiotic Resistance in Italy: A Review of the Literature

“…This is in line with other studies [ 136 , 137 ]. These data are completely different from the past; in fact, our group obtained good results (eradication rates always >85%) with the use of levofloxacin and moxifloxacin-based regimens for both treatment-naive and treatment-experienced patients [ 138 , 139 , 140 ].…”

“…Our research group in the past tried to find other molecules to treat H. pylori infection. A trial with rifaximin plus either clarithromycin or levofloxacin and a PPI showed optimal compliance but a limited eradication rate in adult patients when compared to standard first-line treatment [ 140 ].…”