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Fourth‐line rescue therapy with rifabutin in patients with three Helicobacter pylori eradication failures
Author(s) -
Gisbert J. P.,
CastroFernandez M.,
PerezAisa A.,
Cosme A.,
MolinaInfante J.,
Rodrigo L.,
Modolell I.,
Cabriada J. L.,
Gisbert J. L.,
Lamas E.,
Marcos E.,
Calvet X.
Publication year - 2012
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2012.05053.x
Subject(s) - medicine , rifabutin , helicobacter pylori , clarithromycin , dysgeusia , amoxicillin , regimen , nausea , adverse effect , gastroenterology , urea breath test , metronidazole , vomiting , surgery , antibiotics , helicobacter pylori infection , microbiology and biotechnology , biology
Summary Background In some cases, H elicobacter pylori infection persists even after three eradication treatments. Aim To evaluate the efficacy of an empirical fourth‐line rescue regimen with rifabutin in patients with three eradication failures. Methods Design : Multicentre, prospective study. Patients : In whom the following three treatments had consecutively failed: first ( PPI + clarithromycin + amoxicillin); second ( PPI + bismuth + tetracycline + metronidazole); third ( PPI + amoxicillin + levofloxacin). Intervention : A fourth regimen with rifabutin (150 mg b.d.), amoxicillin (1 g b.d.) and a PPI (standard dose b.d.) was prescribed for 10 days. Outcome : Eradication was confirmed by 13 C‐urea breath test 4–8 weeks after therapy. Compliance and tolerance : Compliance was determined through questioning and recovery of empty medication envelopes. Adverse effects were evaluated using a questionnaire. Results One‐hundred patients (mean age 50 years, 39% men, 31% peptic ulcer/69% functional dyspepsia) were included. Eight patients did not take the medication correctly (in six cases due to adverse effects). Per‐protocol and intention‐to‐treat eradication rates were 52% (95% CI = 41–63%) and 50% (40–60%). Adverse effects were reported in 30 (30%) patients: nausea/vomiting (13 patients), asthenia/anorexia (8), abdominal pain (7), diarrhoea (5), fever (4), metallic taste (4), myalgia (4), hypertransaminasemia (2), leucopenia (<1,500 neutrophils) (2), thrombopenia (<150 000 platelets) (2), headache (1) and aphthous stomatitis (1). Myelotoxicity resolved spontaneously in all cases. Conclusions Even after three previous H . pylori eradication failures, an empirical fourth‐line rescue treatment with rifabutin may be effective in approximately 50% of the cases. Therefore, rifabutin‐based rescue therapy constitutes a valid strategy after multiple previous eradication failures with key antibiotics, such as clarithromycin, metronidazole, tetracycline and levofloxacin.