title: Culture-based selection therapy for patients who did not respond to previous treatment for Helicobacter pylori infection.
abstract: OBJECTIVE
  Eradication of Helicobacter pylori using empiric therapy has become difficult as a result of increasing resistance to antibiotics. We evaluated the efficacy of specific treatments, selected based on response of bacterial samples to culture with clarithromycin, levofloxacin, and metronidazole, for patients infected with resistant strains of H pylori.
  
  
  METHODS
  We performed a prospective study at a single center of 236 consecutive patients with persistent H pylori infection, despite 1 or more treatment attempts, and documented resistance to at least 1 antimicrobial agent (based on bacterial culture tests). Biopsy samples were collected by endoscopy and cultured in selective media. Patients received either 10 days of levofloxacin (250 mg twice daily for 131 patients with susceptible infections) or 12 days of rifabutin (150 mg once daily for 105 patients resistant to levofloxacin) in combination with amoxicillin (1 g twice daily) and esomeprazole (40 mg twice daily). Efficacy of eradication was determined by the (13)C-urea breath test, 6 to 8 weeks after therapy. Compliance and side effects were determined via personal interviews at the end of therapy. Rifabutin toxicity was monitored by analysis of blood samples.
  
  
  RESULTS
  H pylori infection was cured in 118 of the patients who received levofloxacin triple therapy (90%; 95% confidence interval, 85%-95%) and 93 of the patients who received rifabutin triple therapy (88.6%; 95% confidence interval, 82%-95%). In each group, the cure rate did not differ significantly between patients infected with H pylori strains resistant to single or multiple antibiotics. Mild side effects occurred in 15.5% and 14.9% of patients resistant to single or multiple antibiotics, respectively, and self-limiting neutropenia was observed in 1 (0.7%) case.
  
  
  CONCLUSIONS
  Selection of triple therapy with either levofloxacin or rifabutin, based on results from bacterial culture tests, cures H pylori infection in about 90% who did not previously respond to antibiotics.
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Fiorini
authors.forename: Nimish
authors.initials: N
authors.lastname: Vakil
authors.forename: Angelo
authors.initials: A
authors.lastname: Zullo
authors.forename: Ilaria M
authors.initials: IM
authors.lastname: Saracino
authors.forename: Valentina
authors.initials: V
authors.lastname: Castelli
authors.forename: Chiara
authors.initials: C
authors.lastname: Ricci
authors.forename: Cristina
authors.initials: C
authors.lastname: Zaccaro
authors.forename: Luigi
authors.initials: L
authors.lastname: Gatta
authors.forename: Dino
authors.initials: D
authors.lastname: Vaira
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001706:Biopsy; D001944:Breath Tests; D017291:Clarithromycin / Q000494:pharmacology / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005753:Gastric Mucosa / Q000382:microbiology; 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 / Q000627:therapeutic use*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D017828:Rifabutin / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome; D014508:Urea / Q000032:analysis
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D017828:Rifabutin; D014508:Urea; D017291:Clarithromycin