Randomized controlled study of rabeprazole, levofloxacin and rifabutin triple therapy vs. quadruple therapy as second‐line treatment for Helicobacter pylori infection

Abstract

SUMMARYAim: To test the efficacy of rabeprazole, levofloxacin and rifabutin triple therapy vs. quadruple therapy for the second-line treatment of Helicobacter pylori infection. Methods: One hundred and nine patients who had failed previous H. pylori eradication were randomized to receive: (i) rabeprazole, 20 mg b.d., rifabutin, 300 mg once daily, and levofloxacin, 500 mg once daily, for 7 days (triple therapy); or (ii) rabeprazole, 20 mg b.d., metronidazole, 400 mg t.d.s., bismuth subcitrate, 120 mg q.d.s., and tetracycline, 500 mg q.d.s., for 7 days (quadruple therapy). Endoscopy and culture were performed before treatment. Results:The clarithromycin (79% vs. 21%, P < 0.001) and metronidazole (89% vs. 40%, P < 0.001) resistance rates were significantly higher in patients with previous exposure than in those with no previous exposure. The intention-to-treat and per protocol eradication rates were 91%/91% for the triple therapy group and 91%/92% for the quadruple therapy group. For patients with double resistance to metronidazole and clarithromycin, the eradication rates were 85% (17/20) in the triple therapy group and 87% (13/15) in the quadruple therapy group. Compliance was greater than 95% for both regimens. Conclusion: Rabeprazole, levofloxacin and rifabutinbased triple therapy and quadruple therapy were equally effective as second-line treatments for H. pylori infection.

Helicobacter pylori eradication in Western Australia using novel quadruple therapy combinations

“…Similar to other RFB-based triple therapy studies, 34,35 this treatment was shown to deliver a high cure rate of 95.2% (n = 210). The high-dose AMX (3 g/day) 10 days' treatment was adopted from the 'old' dual therapy which was reported with a high cure rate (>90%) in the early years of H. pylori treatment.…”

“…Female patients are more likely to carry H. pylori strains resistant to both CLR and MTZ than male patients due to the higher incidence of previous treatment of gynaecological conditions with antibiotics. 11,[31][32][33][34] Although the resistance rate between genders was not proved statistically significant in this study (Pvalue MTZ = 0.11; P-value CLR = 0.77), the higher ratio of female-to-male patients, especially among the older women, suggests that mature women are more likely to carry antibiotic-resistant strains, which then lead to a poorer eradication rate in standard MTZ/CLR-based treatment.…”

“…36,37 However, the dual therapy only achieved a 67% cure rate in one of our earlier trials. 38 As a result, RFB and a quinolone, a method adopted from Wong WM et al, 34 were combined with the dual therapy to improve the cure rate. CIP was chosen as the quinolone because of its affordability and easy access.…”

Reply to letter to the editor: “The dosage of rifabutin in H. pylori eradication regimen should be appropriately determined in each area of the world”

“…There are few reports of rifabutin-containing regimen from Asia, while most of the reports are from Europe. 3 Meanwhile, Wong et al 4 showed a 91% eradication rate and a 58% adverse-events rate with a rifabutin-containing regimen in China. 4 Both of the Asian eradication rates are higher than those in previous reports.…”

“…3 Meanwhile, Wong et al 4 showed a 91% eradication rate and a 58% adverse-events rate with a rifabutin-containing regimen in China. 4 Both of the Asian eradication rates are higher than those in previous reports. 3 Rifabutin is metabolized and eliminated mainly by the CYP3A pathway and is a moderate inducer of CYP3A4 activity.…”