How efficacious is rifabutin triple therapy for multidrug-resistant Helicobacter pylori?

In the increasing number of patients who harbor multidrug-resistant strains of Helicobacter pylori, a 12-day regimen of low-dose rifabutin/high-dose proton pump inhibitor therapy may be effective and safe, according to study results published in the Journal of Clinical Gastroenterology.

“Eradicating H. pylori continues to be a challenge, and no treatment regimen is uniformly successful in all treated patients,” wrote the authors, led by Giulia Fiorini, MD, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. “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.”

Dr. Fiorini and colleagues studied consecutive patients with dyspeptic symptoms after at least one course of antibiotic therapy for H. pylori infection that harbored triple drug-resistant strains (clarithromycin, metronidazole, and levofloxacin).

For 12 days, 254 patients received treatment with triple therapy comprised of esomeprazole (40 mg twice daily), amoxicillin (1 g twice daily), and rifabutin (150 mg once daily).

Treatment resulted in a cure rate of 82.9% (95% CI: 78.3-87.5), according to intention-to-treat analysis, and 88.7% (95% CI: 84.7-92.7) in the per-protocol analysis. Upon multivariate analysis, researchers found no factor that was 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,” the authors concluded.