Review article: rifabutin in the treatment of refractory Helicobacter pylori infection

Abstract

Aliment Pharmacol Ther 2012; 35: 209–221 Summary Background Even with the current most effective treatment regimens, a relevant proportion of patients will fail to eradicate Helicobacter pylori infection. Aim To evaluate the role of rifabutin in the treatment of H. pylori infection. Methods Bibliographical searches were performed in MEDLINE. Data on the efficacy of rifabutin‐containing regimens on H. pylori eradication were combined and meta‐analysed using the generic inverse variance method. Results Rifabutin shows good in vitro activity against H. pylori. Mean H. pylori rifabutin resistance rate (calculated from 11 studies including 2982 patients) was 1.3% (95% confidence interval = 0.9–1.7%). When only studies including patients naïve to H. pylori eradication treatment were considered, this figure was even lower (0.6%). On the other hand, higher values of rifabutin resistance were calculated (1.59%) when only post‐treatment patients were considered. Overall, mean H. pylori eradication rate (intention‐to‐treat analysis) with rifabutin‐containing regimens (1008 patients) was 73% (67–79%). Respective cure rates for second‐line (223 patients), third‐line (342 patients) and fourth/fifth‐line (95 patients) rifabutin therapies were 79% (67–92%), 66% (55–77%) and 70% (60–79%) respectively. For treating H. pylori infection, almost all studies have administered rifabutin 300 mg/day; this dose seems to be more effective than 150 mg/day. The ideal length of treatment remains unclear, but 10‐ to 12‐day regimens are generally recommended. The mean rate of adverse effects was 22% (19–25%). Myelotoxicity is the most significant, although this complication was rare. Until now, all patients have recovered of leucopenia uneventfully in a few days, and there have been no reports of infection or other adverse outcomes related to it. Conclusion Rifabutin‐containing rescue therapy constitutes an encouraging strategy after multiple (usually three) previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline and levofloxacin.

Quadruple Rescue erapy aer First and Second Line Failure for Helicobacter pylori Treatment: Comparison between Two Tetracycline-Based Regimens

“…Its use in H. pylori eradication regimens is indicated today only for the rescue therapy given the low rates of antibiotic resistance [10], the high economic costs and the potential severe side e ects, such as neutropenia or anemia [11]. A recent meta-analysis showed a mean percentage of success of a third-line rifabutin-based triple therapy (rifabutin, amoxicillin and a PPI) of 66% [6].…”

“…On the other hand, Italian guidelines [5] suggest a rifabutin based triple therapy as a third line. e possibility of using an empiric third-line regimen when culture is not available or most antibiotics have failed is essential, and rifabutin has been investigated in many studies, with a success rate ranging from 44 to 95% [6]. In a recent meta-analysis, the mean percentage of success of a rifabutin-based triple therapy (rifabutin, amoxicillin and a proton pump inhibitor -PPI) was 66% when used in third line [6].…”

“…e possibility of using an empiric third-line regimen when culture is not available or most antibiotics have failed is essential, and rifabutin has been investigated in many studies, with a success rate ranging from 44 to 95% [6]. In a recent meta-analysis, the mean percentage of success of a rifabutin-based triple therapy (rifabutin, amoxicillin and a proton pump inhibitor -PPI) was 66% when used in third line [6]. Tetracycline is a class of antibiotics that is largely used in second and third line therapy [7], usually in association with bismuth and metronidazole, the so called "quadruple therapy".…”

Helicobacter pylorieradication in West Asia: A review

“…Bismuth-based quadruple therapies including quinolones or Furazolidone + Tetracycline are among the candidates [99] . Rifabutin is another drug introduced to be effective in third-line regimens [100,101] . However, its risks include myelotoxicity and severe ocular adverse effects, and if used extensively, may lead to resistant Mycobacterium tuberculosis strains in the future.…”

Trend for Treatment ofHelicobacter pyloriin Overseas Country

“…[65][66][67][68][69][70] 다른 치료에 여러 차 례 실패한 후 이용되었을 때 제균율이 68%인데 반해 rifabutin 포함 제균 치료는 2차 치료로 이용되었을 때 95%로 제균율이 높게 나와 2차 치료 때 가장 효과적인 것으로 보여진다. 71,72 Rifabutin은 항생제 민감도 검사에서 H. pylori에 대한 내성으 …”