title: Rifabutin-based 'rescue therapy' for Helicobacter pylori infected patients after failure of standard regimens.
abstract: BACKGROUND
  The ideal treatment for patients who have failed eradication of Helicobacter pylori infection after standard proton pump inhibitor-based triple therapies has still to be determined. Although either a second course of triple therapy or a quadruple therapy (proton pump inhibitor plus bismuth-based triple therapy) has been proposed, the efficacy of these second-line therapies is relatively unknown. Therefore, alternative strategies are needed.
  
  
  OBJECTIVE
  To assess the efficacy and tolerability of rifabutin, a derivative of rifamycin-S, in patients who were still H. pylori infected after two or more courses of 1-week triple therapies.
  
  
  METHODS
  Patients were given a 1-week regimen of pantoprazole 40 mg b.d. + amoxycillin 1 g b.d. + rifabutin 300 mg daily. Side-effects and compliance were determined at the end of therapy. Eradication rate was assessed with a 13C-urea breath test performed at 4 and 12 weeks after treatment.
  
  
  RESULTS
  Forty-one patients (mean age 47 +/- 15 years) were studied. All patients took medications according to the proposed schedule. Side-effects were infrequent and mild. The eradication rates were 71% (95% CI: 57-85%) on intention-to-treat analysis and 74% (95% CI: 61-88%) on per protocol analysis.
  
  
  CONCLUSIONS
  Rifabutin, in combination with pantoprazole and amoxycillin, is an effective and well tolerated regimen in patients who failed standard eradication treatments.
authors.affiliation: Division of Gastroenterology, 'Casa Sollievo della Sofferenza' Hospital, I.R.C.C.S., San Giovanni Rotondo, Italy. perrisgr@tin.it
authors.forename: F
authors.initials: F
authors.lastname: Perri
authors.forename: V
authors.initials: V
authors.lastname: Festa
authors.forename: R
authors.initials: R
authors.lastname: Clemente
authors.forename: M
authors.initials: M
authors.lastname: Quitadamo
authors.forename: A
authors.initials: A
authors.lastname: Andriulli
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001944:Breath Tests; D016099:Endoscopy, Gastrointestinal; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D054328:Proton Pump Inhibitors; D017828:Rifabutin / Q000009:adverse effects / Q000627:therapeutic use*; D014508:Urea / Q000032:analysis
chemical_list: D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors; D017828:Rifabutin; D014508:Urea