Rifabutin-Based Triple Therapy Or Bismuth-Based Quadruple Regimen As Rescue Therapies For Helicobacter pylori Infection

Saracino, Ilaria Maria; Pavoni, Matteo; Zullo, Angelo; Fiorini, Giulia; Shaughnessy, Laura; Lazzarotto, Tiziana; Antonelli, Guido; Cavallo, Rossana; Borghi, Claudio; Vaira, Dino

doi:10.1016/j.ejim.2020.06.029

Cited by 18 publications

(14 citation statements)

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“…A total of 655 citations were found on PubMed. Following title and abstract reviews, 35 studies met the inclusion criteria, with 72 therapeutic arms and 4830 patients [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ], whilst the others were ultimately excluded for different reasons, as listed in Figure 1 . Overall, there were 26 therapeutic arms on a levofloxacin-based therapy, 25 on a bismuth-based quadruple therapy, including 21 studies with PPI and Pylera ® (a standardized three-in-one capsule, containing bismuth subcitrate potassium (140 mg), metronidazole (125 mg), and tetracycline (125 mg), and 4 studies with standard PPI, bismuth, tetracycline, and metronidazole; 16 on rifabutin-based, and 5 on sequential therapy, whilst no study on concomitant, hybrid or high-dose dual therapy was available.…”

Section: Resultsmentioning

confidence: 99%

Rescue Therapies for H. pylori Infection in Italy

et al. 2021

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Background/Aims: Curing Helicobacter pylori infection remains challenging for clinicians, as no proposed first-line therapy achieves bacterial eradication in all treated patients so that several patients need two or more consecutive treatments. Bacterial culture with antibiotics susceptibility testing is largely unachievable in Italy, and empiric second-line and rescue therapies are generally used. This study aimed to identify what eradication regimens perform better in Italy, following first-line therapy failure. Methods: We performed a literature search on PubMed for studies on standard therapy regimens used as second-line or rescue treatments performed in adult patients. Studies including modified drug combinations were not considered. Both intention-to-treat and per- protocol analyses were computed for each therapy subgroup. Results: Data from 35 studies with a total of 4830 patients were eventually considered. As a second-line therapy, Pylera® (90.6%) and a sequential regimen (89.8%) achieved eradication rates significantly higher than other therapies. For third-line therapy, a levofloxacin-based regimen and Pylera® achieved comparable eradication rates (88.2% vs. 84.7%; p = 0.2). Among therapies used as fourth (or more) attempts, Pylera® and a rifabutin-based therapy achieved 77.4% and 66.4% cure rates, respectively (p = 0.013). A therapy sequence based on the type of first-line therapy used was proposed. Conclusions: Data obtained through our review indicate that standard therapies for H. pylori eradication can be used when following an appropriate sequence, allowing clinicians to improve the cure rate without resorting to bacterial culture.

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Section: Resultsmentioning

confidence: 99%

Rescue Therapies for H. pylori Infection in Italy

et al. 2021

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“…Finally, for the present review, to the best of our knowledge the most updated in the literature, all the studies that have evaluated the efficacy of rifabutin-containing regimens for the treatment of H. pylori infection are summarized in Table 2 [ 19 , 20 , 36 , 39 , 41 , 47 , 48 , 51 , 52 , 57 , 67 , 68 , 69 , 77 , 78 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 ]. Overall, from the 3052 patients treated with rifabutin-containing regimens included in Table 2 , a mean H. pylori eradication rate (by intention-to-treat analysis) of 73% (95% confidence interval (CI), 69–78%) was calculated ( Figure 3 ).…”

Section: Efficacy Of Rifabutin For H Pylori Ermentioning

confidence: 99%

“…On intention-to-treat analysis, eradication rates were 87% for rifabutin-containing therapy and 67% for bismuth quadruple therapy (these differences being statistically significant). More recent studies have shown better results with the rifabutin-triple [ 87 ] or bismuth-quadruple [ 91 , 104 , 108 ] regimen. Finally, the rifabutin-levofloxacin regimen has also been compared with the bismuth quadruple treatment for second-line treatment, reporting similar high eradication rates (91%) and similar good compliance (>95%) [ 86 ].…”

Section: Efficacy Of Rifabutin For H Pylori Ermentioning

confidence: 99%

“…Almost all studies administered rifabutin 300 mg/day for treating H. pylori infection. The H. pylori cure rate in some (few) studies prescribing rifabutin 150 mg/day was only approximately 40–70% [ 36 , 108 ], although other studies reported higher eradication rates [ 20 , 52 , 99 ]. A single randomized study directly compared both doses [ 36 ]: patients were treated for 10 days with pantoprazole, amoxicillin, and rifabutin 150 mg once daily or 300 mg once daily.…”

Section: How To Optimize Rifabutin-based Treatments For mentioning

confidence: 99%

“…Finally, as a fifth-line rescue regimen (including 306 patients), the rifabutin-containing regimen was still quite effective (72%; 95% CI, 67-77%). It has been suggested that rifabutin efficacy decreases with increasing number of previous (failed) therapies, perhaps due to patients who failed eradication therapy and possibly harbored H. pylori strains that were more refractory to eradication treatment [39,108]. Accordingly, in the meta-analysis by Gingold-Belfer et al previously mentioned, treatment success with rifabutin triple therapy was 82% in treatment-naïve patients, 73% in patients receiving second-line treatment, and 64% when this regimen was prescribed as a third-line regimen [80].…”

Section: Efficacy Of Rifabutin For H Pylori Eradicationmentioning

confidence: 99%

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Rifabutin for the Treatment of Helicobacter pylori Infection: A Review

Gisbert¹

2020

Pathogens

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Nowadays, apart from having to know first-line Helicobacter pylori eradication regimens well, we must also be prepared to face treatment failures. The aim of this review is to summarize the role of rifabutin in the management of H. pylori infection. Bibliographical searches were performed in PubMed. Data on resistance and efficacy of rifabutin-containing regimens on H. pylori eradication were meta-analyzed. Mean H. pylori rifabutin resistance rate (39 studies, including 9721 patients) was 0.13%; when studies only including patients naïve to H. pylori eradication treatment were considered, this figure was even lower (0.07%). Mean H. pylori eradication rate (by intention-to-treat) with rifabutin-containing regimens (3052 patients) was 73%. Respective cure rates for second-, third-, fourth- and fifth-line therapies, were 79%, 69%, 69% and 72%. Most studies administered rifabutin 300 mg/day, which seemed to be more effective than 150 mg/day. The ideal length of treatment remains unclear, but 10–12-day regimens are generally recommended. Adverse events to rifabutin treatment in H. pylori studies were relatively infrequent (15%), and severe adverse events were exceptional (myelotoxicity was the most significant, although always reversible). In summary, rifabutin-containing therapy represents an encouraging strategy generally restricted, at present, to patients where previous (usually multiple) eradication regimens have failed.

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