title: Rifabutin- and furazolidone-based Helicobacter pylori eradication therapies after failure of standard first- and second-line eradication attempts in dyspepsia patients.
abstract: BACKGROUND
  Optimal management approach is not well defined for subjects who fail initial first- and second-line Helicobacter pylori eradication attempts and are dealt on a case-by-case basis by the specialists.
  
  
  OBJECTIVE
  To evaluate the efficacy and safety of standard and 'rescue' eradication therapies at primary and secondary care levels.
  
  
  METHODS
  H. pylori infected dyspepsia patients referred to our C13 urea breath testing laboratory between January 1999 to February 2002 were included. Eradication failure at secondary care level was treated using strategies including antibiotic sensitivity testing and the use of rifabutin- and furazolidone-based therapies.
  
  
  RESULTS
  3280 patients received standard first-line eradication therapy, which was successful in 2530 (77%) patients. Second-line therapy (bismuth-based 'quadruple') or triple therapy (altering constituent antibiotics) was successful in 56% of 270 treated patients. Subsequent eradication attempts using rifabutin-based (n = 34) and furazolidone-based (n = 10) regimens were successful in 38% and 60% patients respectively. H. pylori eradication rates were significantly different for guidelines compliant (94.8%) and non-compliant (82%) groups (P = 0.0001). H. pylori eradication rates for non-ulcer dyspepsia (40%) and peptic ulcer disease (36%) were not significantly different.
  
  
  CONCLUSIONS
  Available H. pylori eradication therapies remain very effective and compliance to guidelines achieves high success rates. Furazolidone-based 'rescue' regimen achieved high eradication rates after failure of the standard first-line, second-line and rifabutin-based therapies.
authors.affiliation: Gastroenterology Department, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland.
authors.forename: Asghar
authors.initials: A
authors.lastname: Qasim
authors.forename: Shaji
authors.initials: S
authors.lastname: Sebastian
authors.forename: Orla
authors.initials: O
authors.lastname: Thornton
authors.forename: Mark
authors.initials: M
authors.lastname: Dobson
authors.forename: Ramona
authors.initials: R
authors.lastname: McLoughlin
authors.forename: Martin
authors.initials: M
authors.lastname: Buckley
authors.forename: Humphrey
authors.initials: H
authors.lastname: O'Connor
authors.forename: Colm
authors.initials: C
authors.lastname: O'Morain
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004341:Drug Evaluation; D004351:Drug Resistance; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D004415:Dyspepsia / Q000188:drug therapy*; D005260:Female; D005664:Furazolidone / Q000627:therapeutic use*; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D017828:Rifabutin / Q000627:therapeutic use*; D017211:Treatment Failure
chemical_list: D017828:Rifabutin; D005664:Furazolidone