title: Rifabutin Triple Therapy is Effective in Patients With Multidrug-resistant Strains of Helicobacter pylori.
abstract: Eradicating Helicobacter pylori continues to be a challenge, and no treatment regimen is uniformly successful in all treated patients. Triple therapy with rifabutin and amoxicillin is a successful rescue therapy after consecutive treatment failures. We designed this study to test the efficacy of 12-day rifabutin-based triple therapy in patients infected with multidrug-resistant strains.
  
  
  
  Consecutive patients with dyspeptic symptoms after at least 1 antibiotic therapy course for H. pylori infection harboring triple-resistant (clarithromycin, metronidazole, levofloxacin) strains were enrolled. They received triple therapy with esomeprazole 40 mg bid, amoxicillin 1 g bid, and rifabutin 150 mg od for 12 days. Patients who failed rifabutin therapy were treated empirically on the basis of the judgment of the treating physician.
  
  
  
  A total of 254 out of 756 tested patients were found to be infected with a triple-resistant H. pylori strains after at least 1 antibiotic therapy course. Overall, the infection was eradicated in 213 patients, corresponding to a cure rate of 82.9% (95% CI, 78.3-87.5) by intention-to-treat analysis and 88.7% (95% CI, 84.7-92.7) at per-protocol analysis. In multivariate analysis, no factor was identified as an independent predictor of bacterial eradication.
  
  
  
  There is no current standard for the growing population of patients with multidrug-resistant strains of H. pylori. The 12-day low-dose rifabutin/high-dose proton pump inhibitor regimen is a safe and reliable option for patients infected with triple-resistant strains.
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Bologna.
authors.forename: Giulia
authors.initials: G
authors.lastname: Fiorini
authors.affiliation: Gastroenterology and Digestive Endoscopy, 'Nuovo Regina Margherita' Hospital, Rome.
authors.forename: Angelo
authors.initials: A
authors.lastname: Zullo
authors.affiliation: Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Nimish
authors.initials: N
authors.lastname: Vakil
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Bologna.
authors.forename: Ilaria M
authors.initials: IM
authors.lastname: Saracino
authors.affiliation: Gastroenterology Unit, University of Brescia, Brescia.
authors.forename: Chiara
authors.initials: C
authors.lastname: Ricci
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Bologna.
authors.forename: Valentina
authors.initials: V
authors.lastname: Castelli
authors.affiliation: Gastroenterology and Endoscopy Unit, Versilia Hospital, Lido di Camaiore, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Gatta
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Bologna.
authors.forename: Dino
authors.initials: D
authors.lastname: Vaira
mesh_terms: D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D064098:Esomeprazole / Q000008:administration & dosage*; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D054328:Proton Pump Inhibitors / Q000008:administration & dosage; D017828:Rifabutin / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D017828:Rifabutin; D000658:Amoxicillin; D064098:Esomeprazole