Rifabutin based triple therapy for eradication of H. pylori primary and secondary resistant to tinidazole and clarithromycin

Toracchio, Sonia; Capodicasa, Simona; Soraja, D.B.; Cellini, Luigina; Marzio, L.

doi:10.1016/j.dld.2004.09.008

Cited by 54 publications

(90 citation statements)

References 29 publications

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“…The structurally related rifabutin, originally reserved for the treatment of mycobacterial infections, has been shown to possess high efficacy against H. pylori and is therefore increasingly recommended in drug-resistant H. pylori infections. 5,6 Our data show that rifampicin resistance in H. pylori is still uncommon in Germany, because it occurred in only 1.4% (n ¼ 22) of the examined isolates, without any significant evidence of an increasing trend.…”

Section: Discussionmentioning

confidence: 94%

Characterization of rifampicin-resistant clinical Helicobacter pylori isolates from Germany

Glocker

Bogdan

Kist

2007

Journal of Antimicrobial Chemotherapy

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Objectives: The aim of this study was to assess the rate of rifampicin resistance in Helicobacter pylori isolated from patients in Germany, to detect rifampicin resistance-associated mutations and to identify non-resistance-associated genetic variants in the rpoB gene.Methods: Susceptibility to rifampicin in a total of 1585 clinical isolates obtained between January 2003 and July 2006 was tested by disc diffusion and/or by the Etest w method. The rpoB genes of a selection of both resistant (n 5 17) and susceptible (n 5 100) clinical isolates were sequenced in order to distinguish between resistance-and non-resistance-associated genetic alterations. In vitro mutagenesis experiments such as site-directed mutagenesis were carried out to demonstrate the pivotal role of rpoB mutations in rifampicin resistance.Results: From 1585 clinical isolates examined, 22 (1.4%) showed phenotypic resistance to rifampicin (MIC >4 mg/L). The majority of the resistant strains harboured point mutations in their rpoB genes at codons 530, 540 and 545 and showed cross-resistance to rifabutin. Four clinical isolates with moderate rifampicin resistance (8 mg/L) showed a rifabutin-susceptible phenotype and did not harbour any mutation in the sequenced rpoB fragments. Sequence analysis of 100 rifampicin-susceptible isolates revealed numerous novel silent mutations in the rpoB genes resulting in amino acid exchanges, but not in resistance.Conclusions: Resistance to rifampicin/rifabutin in H. pylori strains isolated in Germany is still low and is associated with mutations in the rpoB gene. Further surveillance studies analysing the use of rifabutin in H. pylori eradication and its association with the occurrence of rifabutin-resistant strains are required.

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Section: Discussionmentioning

confidence: 94%

Characterization of rifampicin-resistant clinical Helicobacter pylori isolates from Germany

Glocker

Bogdan

Kist

2007

Journal of Antimicrobial Chemotherapy

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“…Antimicrobial-related adverse effects represent the main cause of poor compliance, which often lead to eradication failure [21, 23, 64]. This is, for instance, the case of rifabutin-based regimens, which – despite the high cure rates [65,66,67] – are not devoid of serious adverse events [42, 43]. …”

Section: Discussionmentioning

confidence: 99%

Eradication of <i>Helicobacter pylori</i>: Are Rifaximin-Based Regimens Effective?

Gasbarrini

Pelosini

et al. 2006

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Rifaximin is a non-absorbed semisynthetic rifamycin derivative with a broad spectrum of antibacterial activity including Gram-positive and Gram-negative bacteria, both aerobes and anaerobes. Although originally developed for the treatment of infectious diarrhea, the appreciation of the pathogenic role of gut bacteria in several organic and functional gastrointestinal diseases has increasingly broadened its clinical use. Being the antibiotic active against Helicobacter pylori, even towards clarithromycin-resistant strain, and being the primary resistance very rare, several investigations explored its potential use for eradication of the microorganism. Rifaximin alone proved to be effective, but even the highest dose (1,200 mg daily) gave a cure rate of only 30%. Dual and triple therapies were also studied, with the better results obtained with rifaximin-clarithromycin and rifaximin-clarithromycin-esomeprazole combinations. However, the eradication rates (60–70%) obtained with these regimens were still below the standard set by the Maastricht Consensus guidelines. Although rifaximin-based eradication therapies are promising, new antimicrobial combinations (with and without proton pump inhibitors) need to be explored in well-designed clinical trials including a large cohort of H. pylori-infected patients. The remarkable safety of rifaximin will allow high-dose regimens of longer duration (e.g. 10 or 14 days) to be tested with confidence in the hope of achieving better eradication rates. A drawback of rifaximin could be its inability to reach sufficiently high concentrations in the gastric mucus layer under and within which H. pylori is commonly located and this would likely affect eradication rate. Taking these considerations into account, bioadhesive rifaximin formulations able to better and persistently cover gastric mucosa, or combination with mucolytic agents, such as pronase or acetylcysteine, need to be evaluated in order to better define the place of this antibiotic in our therapeutic armamentarium.

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“…As summarized in Table 2, rifabutin-based 'rescue' therapy constitutes an encouraging strategy after multiple previous eradication failures [Gonzalez Carro et al 2007;Navarro-Jarabo et al 2007;Van Der Poorten and Katelaris, 2007;Borody et al 2006;Miehlke et al 2006;Gisbert et al 2006bGisbert et al , 2003Toracchio et al 2005;Beales, 2001;Canducci et al 2001;Bock et al 2000;Perri et al 2000]. As an example, Perri et al [2000Perri et al [ , 1998] used a 1-week regimen of PPI, amoxicillin and rifabutin in patients who were still H. pylori infected after two or more courses of PPI-based triple therapies, and achieved a eradication rate of 71% by intentionto-treat analysis.…”

Section: Amoxicillin±tetracycline-based Regimensmentioning

confidence: 99%

Review: Second-line rescue therapy of Helicobacter pylori infection

Gisbert

2009

Therap Adv Gastroenterol

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Helicobacter pylori infection is the main known cause of gastritis, gastroduodenal ulcer disease and gastric cancer. After more than 20 years of experience in H. pylori treatment, however, the ideal regimen to treat this infection has still to be found. Nowadays, apart from having to know well first-line eradication regimens, we must also be prepared to face treatment failures. Therefore, in designing a treatment strategy we should not focus on the results of primary therapy alone, but also on the final (overall) eradication rate. The choice of a 'rescue' treatment depends on which treatment is used initially. If a first-line clarithromycin-based regimen was used, a second-line metronidazole-based treatment (quadruple therapy) may be used afterwards, and then a levofloxacin-based combination would be a third-line 'rescue' option. Alternatively, it has recently been suggested that levofloxacin-based 'rescue' therapy constitutes an encouraging second-line strategy, representing an alternative to quadruple therapy in patients with previous PPI-clarithromycin-amoxicillin failure, with the advantage of efficacy, simplicity and safety. In this case, quadruple regimen may be reserved as a third-line 'rescue' option. Finally, rifabutin-based 'rescue' therapy constitutes an encouraging empirical fourth-line strategy after multiple previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline, and levofloxacin. Even after two consecutive failures, several studies have demonstrated that H. pylori eradication can finally be achieved in almost all patients if several 'rescue' therapies are consecutively given. Therefore, the attitude in H. pylori eradication therapy failure, even after two or more unsuccessful attempts, should be to fight and not to surrender.

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Rifabutin based triple therapy for eradication of H. pylori primary and secondary resistant to tinidazole and clarithromycin

Cited by 54 publications

References 29 publications

Characterization of rifampicin-resistant clinical Helicobacter pylori isolates from Germany

Characterization of rifampicin-resistant clinical Helicobacter pylori isolates from Germany

Eradication of <i>Helicobacter pylori</i>: Are Rifaximin-Based Regimens Effective?

Review: Second-line rescue therapy of Helicobacter pylori infection

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