Abstract
Nowadays, apart from having to know first-line Helicobacter pylori eradication regimens well, we must also be prepared to face treatment failures. The aim of this review is to summarize the role of rifabutin in the management of H. pylori infection. Bibliographical searches were performed in PubMed. Data on resistance and efficacy of rifabutin-containing regimens on H. pylori eradication were meta-analyzed. Mean H. pylori rifabutin resistance rate (39 studies, including 9721 patients) was 0.13%; when studies only including patients naïve to H. pylori eradication treatment were considered, this figure was even lower (0.07%). Mean H. pylori eradication rate (by intention-to-treat) with rifabutin-containing regimens (3052 patients) was 73%. Respective cure rates for second-, third-, fourth- and fifth-line therapies, were 79%, 69%, 69% and 72%. Most studies administered rifabutin 300 mg/day, which seemed to be more effective than 150 mg/day. The ideal length of treatment remains unclear, but 10–12-day regimens are generally recommended. Adverse events to rifabutin treatment in H. pylori studies were relatively infrequent (15%), and severe adverse events were exceptional (myelotoxicity was the most significant, although always reversible). In summary, rifabutin-containing therapy represents an encouraging strategy generally restricted, at present, to patients where previous (usually multiple) eradication regimens have failed.
Highlights
Helicobacter pylori (H. pylori) is a worldwide infection that is the main cause of gastritis, and of peptic ulcer disease and gastric cancer [1]
A rescue regimen including a quadruple combination of a pump inhibitor (PPI), bismuth, tetracycline, and metronidazole is generally used as the optimal second-line approach after initial H. pylori eradication failure [4,5,6]
We will review the following topics: (1) rifabutin’s general antimicrobial activity and mechanism of action; (2) pharmacokinetics and pharmacodynamics of rifabutin; (3) prevalence of resistance of H. pylori to rifabutin; (4) efficacy of rifabutin for H. pylori eradication; (5) optimization strategies aimed to increase the efficacy of rifabutin-based therapies; (6) safety of rifabutin; and, (7) limitations of rifabutin for the treatment of H. pylori infection
Summary
Helicobacter pylori (H. pylori) is a worldwide infection that is the main cause of gastritis, and of peptic ulcer disease and gastric cancer [1]. A rescue regimen including a quadruple combination of a PPI, bismuth, tetracycline, and metronidazole is generally used as the optimal second-line approach after initial H. pylori eradication failure [4,5,6]. This treatment fails to eradicate the infection in at least 20% of cases [7,8,9,10]. We will review the following topics: (1) rifabutin’s general antimicrobial activity and mechanism of action; (2) pharmacokinetics and pharmacodynamics of rifabutin; (3) prevalence of resistance of H. pylori to rifabutin; (4) efficacy of rifabutin for H. pylori eradication; (5) optimization strategies aimed to increase the efficacy of rifabutin-based therapies; (6) safety of rifabutin; and, (7) limitations of rifabutin for the treatment of H. pylori infection
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