title: Rifabutin Containing Triple Therapy and Rifabutin with Bismuth Containing Quadruple Therapy for Third-Line Treatment of Helicobacter pylori Infection: Two Pilot Studies.
abstract: OBJECTIVE
  To evaluate the therapeutic gain of the addition of bismuth to a rifabutin containing triple therapy with amoxicillin and pantoprazole at standard dosages for the treatment of third-line Helicobacter pylori infection after a preliminary susceptibility test.
  
  
  METHODS
  Two separate groups of patients in two pilot studies which were carried out simultaneously. One group was treated with rifabutin 150 mg b.i.d., pantoprazole 20 mg b.i.d., and amoxicillin 1 g b.i.d. for 10 days and the other group with rifabutin 150 mg b.i.d., pantoprazole 20 mg b.i.d., amoxicillin 1 g b.i.d., and bismuth subcitrate 240 mg b.i.d. for 10 days. All patients underwent to culture and susceptibility testing prior to their inclusion in the study. A successful outcome was confirmed with an Urea Breath test performed 8 weeks after the end of treatment. A blood cell count was performed for all patients at the start and after 5 days of treatment since rifabutin has been shown to inhibit the growth of leucocytes.
  
  
  RESULTS
  Twenty-nine patients were recruited in the pantoprazole, amoxicillin, rifabutin group and 30 in the pantoprazole, amoxicillin, rifabutin, and bismuth subcitrate group. All patients had a positive H. pylori culture and the susceptibility test used showed H. pylori sensitivity to rifabutin and amoxicillin. H. pylori eradication during follow-up was 18/27 (66.7%, 95% CI: 47.7-85.7%) in the pantoprazole, amoxicillin, rifabutin group and 28/29 (96.6%, 95% CI: 89.5-100.0%) in the pantoprazole, amoxicillin, rifabutin, and bismuth subcitrate group. Both treatments were well-tolerated with no reported side effects. Blood cell count remained normal in all patients.
  
  
  CONCLUSIONS
  The addition of bismuth subcitrate to a triple therapy that includes proton pump inhibitors, amoxicillin, and rifabutin in patients who are treated for the third time for H. pylori infection resulted in a 30% therapeutic gain.
authors.affiliation: Digestive Sciences Unit, Pescara Civic Hospital, G. d'Annunzio University, Pescara, Italy.
authors.forename: Antonio Francesco
authors.initials: AF
authors.lastname: Ciccaglione
authors.affiliation: Digestive Sciences Unit, Pescara Civic Hospital, G. d'Annunzio University, Pescara, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Tavani
authors.affiliation: Digestive Sciences Unit, Pescara Civic Hospital, G. d'Annunzio University, Pescara, Italy.
authors.forename: Laurino
authors.initials: L
authors.lastname: Grossi
authors.affiliation: Departments of Drug Sciences, G. d'Annunzio University, Chieti, Italy.
authors.forename: Luigina
authors.initials: L
authors.lastname: Cellini
authors.affiliation: Department of Medicine and Aging Sciences, G. d'Annunzio University, Chieti, Italy.
authors.forename: Lamberto
authors.initials: L
authors.lastname: Manzoli
authors.affiliation: Digestive Sciences Unit, Pescara Civic Hospital, G. d'Annunzio University, Pescara, Italy. marzio@unich.it.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Marzio
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001729:Bismuth / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077402:Pantoprazole; D010865:Pilot Projects; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D017828:Rifabutin / Q000627:therapeutic use*; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D017828:Rifabutin; D000658:Amoxicillin; D000077402:Pantoprazole; D001729:Bismuth
keywords: Helicobacter pylori infection; amoxicillin; bismuth subcitrate; quadruple therapy; rifabutin; third-line therapy