Rifabutin-Based Eradication Therapy after Failure of Standard First- and Second-Line Eradication Therapies in Helicobacter Pylori Infected Patients

Background and aims: Various 'rescue' treatments are used in Helicobacter pylori (H pylori) infected patients who fail standard and secondary eradication therapies. We evaluated the efficacy and safety of rifabutin-based eradication therapy in H pylori infected patients with two or more failed eradication attempts.

Patients and methods: H pylori infected patients with two or more failed attempts included. H pylori status was determined using UBT both pre and post therapy. Patients who took rifabutin 150mg, amoxicillin 1gm or alternative antimicrobial and standard dose of proton pump inhibitor (PPI) twice daily for at least one week were included. Eradication efficacy evaluated in relation to previously used eradication therapies, endoscopic findings and histological changes.

Results: Twenty-H pylori infected patients (15-females) mean age 32 years (17–65 years) with two (15-patients) or more (5-patients) failed eradication attempts were included. Overall eradication was successful in 8-patients (39%) following rifabutin-based regimen. No significant eradication differences among patients with peptic ulcer (33%) and non-ulcer dyspepsia (40%). Eradication rates were higher in patients with a previously failed 2^nd line RBC-based therapy than a failed standard quadruple therapy (28%). Eradication rates in patients with pangastritis and antral gastritis were 38% and 44% respectively. Two patients developed therapy related side effects (discontinuation in one on second day). The other patient developed reversible pancytopenia post therapy.

Conclusions: Rifabutin-based 'rescue' therapy produced sub-optimal eradication rates in patients with previously failed first and second-line H pylori eradication therapies. Such therapy was more successful in patients who previously failed a RBC-based 2^nd line therapy.