In some cases, Helicobacter pylori infection persists even after three eradication treatments.
Dr Gisbert and colleagues from Spain evaluated the efficacy of an empirical fourth-line rescue regimen with rifabutin in patients with three eradication failures.
Patients were included in whom the following 3 treatments had consecutively failed: first (PPI + clarithromycin + amoxicillin); second (PPI + bismuth + tetracycline + metronidazole); third (PPI + amoxicillin + levofloxacin).
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.
|Per-protocol treat eradication rates were 52%|
|Alimentary Pharmacology & Therapeutics|
The team confirmed eradication by 13C-urea breath test 4–8 weeks after therapy.
The research team determined compliance through questioning and recovery of empty medication envelopes.
Adverse effects were evaluated using a questionnaire.
The researchers included 100 patients.
The research team found that 8 patients did not take the medication correctly.
Per-protocol and intention-to-treat eradication rates were 52% and 50%.
The team noted that adverse effects were reported in 30% of patients.
Adverse events included nausea/vomiting, asthenia/anorexia, abdominal pain, diarrhea, fever, metallic taste, myalgia, hypertransaminasemia, leucopenia, thrombopenia, headache, and aphthous stomatitis.
The research team found that myelotoxicity resolved spontaneously in all cases.
Dr Gisbert's team commented, "Even after 3 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."