title: One-week once-daily triple therapy with esomeprazole, moxifloxacin, and rifabutin for eradication of persistent Helicobacter pylori resistant to both metronidazole and clarithromycin.
abstract: OBJECTIVE
  To investigate a 1-week once-daily triple therapy with esomeprazole, moxifloxacin, and rifabutin for rescue therapy of Helicobacter pylori infection.
  
  
  METHODS
  Consecutive patients (n = 103) with at least one previous treatment failure and H. pylori infection resistant to both metronidazole and clarithromycin were treated with esomeprazole 40 mg, moxifloxacin 400 mg, and rifabutin 300 mg, given once daily for 7 days. Eradication was confirmed by histology and culture. CYP2C19 status was determined by polymerase chain reaction-restriction fragment length polymorphism.
  
  
  RESULTS
  Intention-to-treat and per-protocol eradication rates were 77.7% (68.4-85.3) and 83.3% (74.4-90.2). Five patients discontinued prematurely (4.8%). Eradication was achieved in 93.1% of poor/intermediate metabolizers and in 78.8% of homozygous extensive metabolizers (p = .14). Eradication rates in patients with one, two, three, and four or more previous failures were 78.3%, 89.6%, 68.6%, and 88.9%, respectively (p = .21). The regimen was effective in seven of nine patients who previously failed quadruple therapy. Post-treatment resistance to moxifloxacin and rifabutin was detected in two (12.5%) and five (31%) patients after treatment failure.
  
  
  CONCLUSIONS
  Once-daily triple therapy with esomeprazole, moxifloxacin, and rifabutin is a promising, safe, and convenient regimen for rescue therapy of H. pylori infection that may serve as a valuable alternative to quadruple therapy, particularly for patients with intolerance to amoxicillin.
authors.affiliation: Medical Department I, Technical University Hospital, Dresden, Germany. stephan.miehlke@uniklinikum-dresden.de
authors.forename: Stephan
authors.initials: S
authors.lastname: Miehlke
authors.forename: Wulf
authors.initials: W
authors.lastname: Schneider-Brachert
authors.forename: Christian
authors.initials: C
authors.lastname: Kirsch
authors.forename: Andrea
authors.initials: A
authors.lastname: Morgner
authors.forename: Ahmed
authors.initials: A
authors.lastname: Madisch
authors.forename: Eberhard
authors.initials: E
authors.lastname: Kuhlisch
authors.forename: Christian
authors.initials: C
authors.lastname: Haferland
authors.forename: Elke
authors.initials: E
authors.lastname: Bästlein
authors.forename: Claus
authors.initials: C
authors.lastname: Jebens
authors.forename: Christian
authors.initials: C
authors.lastname: Zekorn
authors.forename: Holger
authors.initials: H
authors.lastname: Knoth
authors.forename: Manfred
authors.initials: M
authors.lastname: Stolte
authors.forename: Norbert
authors.initials: N
authors.lastname: Lehn
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics; D001372:Aza Compounds / Q000008:administration & dosage / Q000627:therapeutic use*; D017291:Clarithromycin / Q000494:pharmacology; D065731:Cytochrome P-450 CYP2C19; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D064098:Esomeprazole / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D024841:Fluoroquinolones; D005753:Gastric Mucosa / Q000473:pathology; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000494:pharmacology; D008875:Middle Aged; D006899:Mixed Function Oxygenases / Q000235:genetics; D000077266:Moxifloxacin; D012150:Polymorphism, Restriction Fragment Length; D011446:Prospective Studies; D011804:Quinolines / Q000008:administration & dosage / Q000627:therapeutic use*; D017828:Rifabutin / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D008795:Metronidazole; D017828:Rifabutin; D006899:Mixed Function Oxygenases; D001189:Aryl Hydrocarbon Hydroxylases; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D017291:Clarithromycin; D064098:Esomeprazole; D000077266:Moxifloxacin