Korean J Gastroenterol.  2017 Feb;69(2):109-118. 10.4166/kjg.2017.69.2.109.

Rifabutin-based Fourth and Fifth-line Rescue Therapy in Patients with for Helicobacter pylori Eradication Failure

• Sung J
• Kim N
• Park YH
• Hwang YJ
• Kwon S
• Na G
• Choi JY
• Kang JB
• Kim HR
• Kim JW
• Lee DH

• KMID: 2383420
• DOI: http://doi.org/10.4166/kjg.2017.69.2.109

Abstract

BACKGROUND/AIMS
Optimized regimen has not yet been established for failures of multiple Helicobacter pylori (H. pylori) eradication. Hence, we aimed to evaluate the efficacy of rifabutin-based rescue therapy, at least after three eradication failures.
METHODS
Twelve patients, who failed in the treatment for H. pylori eradication at least three times, were consecutively enrolled between 2007 and 2015 at Seoul National University Bundang Hospital. The rifabutin-based rescue regimen was consisted of proton pump inhibitor (PPI), rifabutin (150 mg b.i.d.), and amoxicillin (1 g b.i.d.), given for 7 or 14 days. MIC concentration test by the agar dilution method was performed on six patients prior to rifabutin-based rescue therapy.
RESULTS
One patient did not take this regimen, and per-protocol (PP) analysis was performed in 11 patients. The overall eradication rate by intention-to-treat and PP analysis with rifabutin-based rescue therapy was 50.0% (6/12 patients) and 54.5% (6/11 patients), respectively. There was no difference of the eradication rate depending on the underlying disease, smoking, alcohol, number of previous eradication failures, and CYP2C19 genotype. All of the six patients were susceptible to rifabutin, but only three of them succeeded in eradicating with H. pylori. Side effects occurred in two patients (18.2%), and compliance was 90.9%.
CONCLUSIONS
Even the eradication rate of rifabutin-based rescue therapy was not very good. Rifabutin-based rescue therapy could be considered as a rescue therapy, perhaps as the fourth or the fifth-line treatment option. No correlation of rifabutin sensitivity with eradication success rate of H. pylori suggests that frequent administration of high dose PPI and amoxicillin might be important.

Keyword

Helicobacter pylori; Eradication; Salvage therapy; Rifabutin

MeSH Terms

Agar
Amoxicillin
Compliance
Cytochrome P-450 CYP2C19
Genotype
Helicobacter pylori*
Helicobacter*
Humans
Methods
Proton Pumps
Rifabutin
Salvage Therapy
Seoul
Smoke
Smoking
Agar
Amoxicillin
Cytochrome P-450 CYP2C19
Proton Pumps
Rifabutin
Smoke

Figure

• 

  Fig. 1. Flow chart of the study and eradication rate by rifabutin-based rescue therapy. ITT, intention-to-treat; PP, per-protocol.

Reference

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