Rifabutin-Containing Triple Therapy Versus Bismuth Quadruple Therapy for Helicobacter pylori Rescue Treatment: A Multicenter, Randomized Controlled Trial

Abstract

Background To compare the efficacy and safety of rifabutin-containing triple therapy with bismuth quadruple therapy for rescue treatment of Helicobacter pylori (H. pylori). Methods This was a non-inferiority study trial of H. pylori treatment for subjects who had failed at least two prior treatments. Subjects were randomly assigned to receive rifabutin triple therapy with 14-day esomeprazole (20 mg bid), amoxicillin (1.0 g bid) and rifabutin (150 mg bid) or bismuth quadruple therapy with esomeprazole (20 mg bid), bismuth (220 mg bid), plus metronidazole (400 mg qid) and tetracycline (500 mg qid). Antimicrobial susceptibility was assessed by agar dilution and E-test methods. Findings From May 2021 to October 2022, a total of 364 subjects were randomized. The eradication rates by intention-to-treat, per-protocol, and modified intention-to-treat were 89.0% (162/182, 95% confidence interval (CI) 83.6%-92.8%), 94.0% (157/167, 95% CI 89.3%-96.7%) and 93.6% (162/173, 95% CI 89.0%-96.4%) for rifabutin triple group. For bismuth quadruple group, they were 89.6% (163/182, 95% CI 84.3%-93.2%), 95.3% (143/150, 95% CI 90.7%-97.7%) and 93.7% (163/174, 95% CI 89.0%-96.4%). Interpretation The rifabutin triple therapy is an alternative to classical bismuth quadruple therapy for the rescue treatment of H. pylori with lower side effects and higher compliance.

Clarifying varied Helicobacter pylori eradication therapies: A comprehensive review

“…In a study conducted in China, 364 patients were divided into two groups: the TT group (treated with 20 mg esomeprazole, 1000 mg amoxicillin, and 150 mg rifabutin, twice daily) and the BQT group (treated with 20 mg esomeprazole, 220 mg bismuth twice daily, along with 400 mg metronidazole, and 500 mg tetracycline four times daily). The results demonstrated that the therapeutic efficacy of the TT group was comparable to that of the BQT group (ITT analysis: 89.0% vs. 89.6%, p = 0.866; PP analysis: 94.0% vs. 95.3%, p = 0.602) 65 …”

“…The results demonstrated that the therapeutic efficacy of the TT group was comparable to that of the BQT group (ITT analysis: 89.0% vs. 89.6%, p = 0.866; PP analysis: 94.0% vs. 95.3%, p = 0.602). 65 However, it is important to note that not all low-resistance antibiotic TTs are equally effective. A meta-analysis pooling data from 23 studies on semi-synthetic tetracycline found eradication rates in TT to be lower than 70% in both ITT and PP analyses.…”

Current and Future Perspectives on the Management of Helicobacter pylori: A Narrative Review

“…It was noted that isolates with amoxicillin resistance were less likely to be successfully eradicated using rifabutin-based treatment, with a drop in eradication from 94.8% to 66.7%. It did not have the same effect on those in the bismuth group [ 50 ].…”