title: Fourth-line rescue therapy with rifabutin in patients with three Helicobacter pylori eradication failures.
abstract: BACKGROUND
  In some cases, Helicobacter pylori infection persists even after three eradication treatments.
  
  
  OBJECTIVE
  To evaluate the efficacy of an empirical fourth-line rescue regimen with rifabutin in patients with three eradication failures.
  
  
  METHODS
  
  
  
  METHODS
  Multicentre, prospective study.
  
  
  METHODS
  In whom the following three treatments had consecutively failed: first (PPI + clarithromycin + amoxicillin); second (PPI + bismuth + tetracycline + metronidazole); third (PPI + amoxicillin + levofloxacin).
  
  
  METHODS
  A fourth regimen with rifabutin (150 mg b.d.), amoxicillin (1 g b.d.) and a PPI (standard dose b.d.) was prescribed for 10 days.
  
  
  RESULTS
  Eradication was confirmed by (13) C-urea breath test 4-8 weeks after therapy. Compliance and tolerance: Compliance was determined through questioning and recovery of empty medication envelopes. Adverse effects were evaluated using a questionnaire.
  
  
  RESULTS
  One-hundred patients (mean age 50 years, 39% men, 31% peptic ulcer/69% functional dyspepsia) were included. Eight patients did not take the medication correctly (in six cases due to adverse effects). Per-protocol and intention-to-treat eradication rates were 52% (95% CI = 41-63%) and 50% (40-60%). Adverse effects were reported in 30 (30%) patients: nausea/vomiting (13 patients), asthenia/anorexia (8), abdominal pain (7), diarrhoea (5), fever (4), metallic taste (4), myalgia (4), hypertransaminasemia (2), leucopenia (<1,500 neutrophils) (2), thrombopenia (<150,000 platelets) (2), headache (1) and aphthous stomatitis (1). Myelotoxicity resolved spontaneously in all cases.
  
  
  CONCLUSIONS
  Even after three previous H. pylori eradication failures, an empirical fourth-line rescue treatment with rifabutin may be effective in approximately 50% of the cases. Therefore, rifabutin-based rescue therapy constitutes a valid strategy after multiple previous eradication failures with key antibiotics, such as clarithromycin, metronidazole, tetracycline and levofloxacin.
authors.affiliation: Gastroenterology Department, Hospital de La Princesa, Madrid, Spain. gisbert@meditex.es
authors.forename: J P
authors.initials: JP
authors.lastname: Gisbert
authors.forename: M
authors.initials: M
authors.lastname: Castro-Fernandez
authors.forename: A
authors.initials: A
authors.lastname: Perez-Aisa
authors.forename: A
authors.initials: A
authors.lastname: Cosme
authors.forename: J
authors.initials: J
authors.lastname: Molina-Infante
authors.forename: L
authors.initials: L
authors.lastname: Rodrigo
authors.forename: I
authors.initials: I
authors.lastname: Modolell
authors.forename: J L
authors.initials: JL
authors.lastname: Cabriada
authors.forename: J L
authors.initials: JL
authors.lastname: Gisbert
authors.forename: E
authors.initials: E
authors.lastname: Lamas
authors.forename: E
authors.initials: E
authors.lastname: Marcos
authors.forename: X
authors.initials: X
authors.lastname: Calvet
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004415:Dyspepsia / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010437:Peptic Ulcer / Q000188:drug therapy* / Q000382:microbiology; D011446:Prospective Studies; D017828:Rifabutin / Q000009:adverse effects / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D017828:Rifabutin