Rifabutin Triple Therapy is Effective in Patients With Multidrug-resistant Strains of Helicobacter pylori

Fiorini, Giulia; Zullo, Angelo; Vakil, Nimish; Saracino, Ilaria Maria; Ricci, Chiara; Castelli, Vincenzo Parenti; Gatta, Luigi; Vaira, Dino

doi:10.1097/mcg.0000000000000540

Cited by 33 publications

(40 citation statements)

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“…We also add to a growing experience that rifabutin‐containing regimens may be effective for resistant HP infections . Studies in the Netherlands, Italy and Germany have demonstrated that rifabutin resistance is rare, and it is overall considered a third or fourth line agent .…”

Section: Discussionmentioning

confidence: 91%

“…15,16 We also add to a growing experience that rifabutin-containing regimens may be effective for resistant HP infections. [17][18][19] Studies in the Netherlands, Italy and Germany have demonstrated that rifabutin resistance is rare, and it is overall considered a third or fourth line agent. 1,3,20 Rifabutin based therapies are not without side effects, however, as a reversible myelotoxicity has been described, though its reversibility and lack of association with increased infections is notable.…”

Section: Discussionmentioning

confidence: 99%

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Resistance patterns of refractory Helicobacter pylori infection in a referral centre in the Delaware Valley

et al. 2020

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Summary Introduction Helicobacter pylori (HP) resistance is increasing in the US. Guidelines suggest treatment based on local resistance patterns, yet are poorly studied. Here, we describe resistance patterns of the Delaware Valley. Methods Retrospective study of patients referred to the Hospital of the University of Pennsylvania, between 2009 and 2019 who underwent endoscopy for culture. Chart review identified demographics, history, endoscopic and culture results, treatment and follow‐up. Results Of 109 patients referred for refractory HP, 90 had identified HP. Median age was 53.2 years and the majority was female (74%), with a median two previous antibiotic courses for HP. Gastric erythema was the most common endoscopic abnormality. Sixty‐five (72.2%) were culture positive, and 45 (69.2%) were resistant to levofloxacin, 27 (41.5%) to metronidazole and 39 (43.3%) to clarithromycin. Being resistant to any one of the three antibiotics was associated with resistance to either of the other two. There was an association with number of previous antibiotics with resistance (OR 1.74, P < 0.05). We prescribed therapy to 77 patients based on susceptibility profiles, and 34 (37.8%) were cured, 14 (15.6%) underwent endoscopic surveillance, 3 (3.3%) were followed by infectious disease, and 39 (43.3%) were lost to follow up. Conclusions Antibiotic resistance is associated with refractory HP, and continues to rise. Culturing is associated with cure, and its use in clinical practice regarding efficacy, cost‐effectiveness and ability to minimise antibiotic resistance should be further studied. Overall follow‐up is limited by loss to follow‐up, emphasising the need for appropriate treatment.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Resistance patterns of refractory Helicobacter pylori infection in a referral centre in the Delaware Valley

et al. 2020

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“…Less impressive results were found in a 12‐patient cohort in Korea in whom only 50% achieved eradication although this study was significantly skewed by the fact that some patients received therapy for 7 days and others 14 days . In a large study from Italy looking at 254 patients harboring triple‐resistant (clarithromycin, metronidazole, levofloxacin) strains 82.9% of the patients were cured with a rifabutin‐based triple therapy …”

Section: Rifabutinmentioning

confidence: 89%

Treatment of Helicobacter pylori infection 2017

et al. 2017

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Over the last decade, it has been widely reported that the success of Helicobacter pylori eradication treatment is falling. A steady decline was observed in the number of patients achieving eradication with standard first-line triple therapy of two antibiotics and a proton pump inhibitor [1][2][3]. It now appears that the first-line eradication therapies most commonly used in everyday clinical practice fall considerably short of the 80% intention-to-treat (ITT) eradication rates that are considered the minimal acceptable levels as recommended in the Maastricht guidelines [4]. Interestingly, two studies emerged from Asian centers in the last 12 months, which show that, in this part of the world at least, eradication levels using standard therapies remain close to 80%. A Malaysian study showed a standard 1-week pantoprazole, amoxycillin, and clarithromycin regimen to be well tolerated and highly efficacious with a per-protocol eradication rate of 84% [5]. A Japanese study showed remarkably consistent per-protocol eradication rates from 2001 to 2009 fluctuating between 75 and 78% for standard 7-day triple-therapy regimens [6]. A limit of many studies especially those including clarithromycin or levofloxacin is that H. pylori susceptibility to the drugs, which is the main prediction of failure, was not tested. LevofloxacinThe use of levofloxacin as a first-line therapy has been examined in great depth in the last year. Levofloxacin may be used as a substitute for clarithromycin in either a standard triple or sequential regimen. A large study comparing the antibiotics in either regimen shows a clear advantage to levofloxacin in both combinations. Per-protocol cure rates for triple therapy were 66% for omeprazole-clarithromycin-amoxycillin compared with 83% for omeprazole-levofloxacin-amoxycillin and 81% for omeprazole-amoxycillin-clarithromycin-metronidazole vs 85% for omeprazole-amoxycillin-levofloxacinmetronidazole, with no difference in compliance rates or adverse events [7]. It has been proposed that sequential levofloxacin-based regimens are of most benefit in areas where clarithromycin resistance is in excess of 15%, and another study in such an area showed eradication rates of 81% with clarithromycin sequential therapy compared with 96% with levofloxacin sequential therapy. A third arm in this study looked at the dose of levofloxacin required and illustrated no benefit in increasing the dose from 250 to 500 mg [8]. Indeed, another study went so far as to suggest that once-daily dosing of a levofloxacin-based triple regimen may be as efficacious as twice daily [9]. The literature from Asia also seems to support levofloxacin as a good alternative first-line therapy. A study on a triple regimen showed per-protocol eradication rates of 78% for standard clarithromycin-containing therapies compared with 83% for a levofloxacin-based regimen [10]. Another study from the Middle East looked at whether combining clarithromycin and levofloxacin in the same regimen could be Keywords Peptic ulcer disease, resistance, compli...

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“…This negative change in RFB efficacy could be related to multiple failed eradication attempts, although the exact mechanisms are not known. 10 The most prominent side effect has been reported as myelotoxicity which occurs rarely due to high dose and long-term consumption of RFB. 3 Similarly, in an Australian study on 67 patients, eradication rate of RFB-based triple therapy was found as 95% after one previous failure and 68% after more than one previous failure.…”

Section: Re Sultsmentioning

confidence: 99%

“…9 According to reports, a considerable number of patients who are not cured with first-or second-line treatment strategies might harbor MDR H. pylori, a challenging situation for clinicians. 10 Furthermore, recent reports show that H. pylori isolates from different groups of patients, for example, from different geographical regions, might have different patterns of antibiotic resistance. 10 Furthermore, recent reports show that H. pylori isolates from different groups of patients, for example, from different geographical regions, might have different patterns of antibiotic resistance.…”

mentioning

confidence: 99%

Effective antimicrobial activity of rifabutin against multidrug‐resistant Helicobacter pylori

2018

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Rifabutin Triple Therapy is Effective in Patients With Multidrug-resistant Strains of Helicobacter pylori

Abstract: There is no current standard for the growing population of patients with multidrug-resistant strains of H. pylori. The 12-day low-dose rifabutin/high-dose proton pump inhibitor regimen is a safe and reliable option for patients infected with triple-resistant strains.

Cited by 33 publications

References 18 publications

Resistance patterns of refractory Helicobacter pylori infection in a referral centre in the Delaware Valley

Resistance patterns of refractory Helicobacter pylori infection in a referral centre in the Delaware Valley

Treatment of Helicobacter pylori infection 2017

Effective antimicrobial activity of rifabutin against multidrug‐resistant Helicobacter pylori

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