Experience with Rifabutin-Containing Therapy in 500 Patients from the European Registry on Helicobacter pylori Management (Hp-EuReg)

Background: First-line Helicobacter pylori (H. pylori) treatments have been relatively well evaluated; however, it remains necessary to identify the most effective rescue treatments. Our aim was to assess the effectiveness and safety of H. pylori regimens containing rifabutin. METHODS: International...

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Authors: Nyssen, Olga P., Vaira, Dino, Saracino, Ilaria Maria, Fiorini, Giulia, Caldas, María, Bujanda Fernández de Pierola, Luis, Pellicano, Rinaldo, Keco-Huerga, Alma, Pabón-Carrasco, Manuel, Oblitas Susanibar, Elida, Di Leo, Alfredo, Losurdo, Giuseppe, Pérez-Aísa, Ángeles, Gasbarrini, Antonio, Boltin, Doron, Smith, Sinead, Phull, Perminder, Rokkas, Theodore, Lamarque, Dominique, Cano-Català, Anna, Puig, Ignasi, Mégraud, Francis, O’Morain, Colm, Gisbert, Javier P.
Format: article
Publication Date:2022
Country:España
Institution:Universidad del País Vasco
Repository:Addi. Archivo Digital para la Docencia y la Investigación
OAI Identifier:oai:addi.ehu.eus:10810/57840
Online Access:http://hdl.handle.net/10810/57840
Access Level:Open access
Keyword:helicobacter pylori
H
pylori
rifabutin
treatment
eradication failure
culture
bismuth
rescue
Hp-EuReg
triple therapy
rescue therapy
quadruple therapy
infected patients
eradication
resistant
failure
levofloxacin
metronidazole
3rd-line
Description
Summary:Background: First-line Helicobacter pylori (H. pylori) treatments have been relatively well evaluated; however, it remains necessary to identify the most effective rescue treatments. Our aim was to assess the effectiveness and safety of H. pylori regimens containing rifabutin. METHODS: International multicentre prospective non-interventional European Registry on H. pylori Management (Hp-EuReg). Patients treated with rifabutin were registered in AEG-REDCap e-CRF from 2013 to 2021. Modified intention-to-treat and per-protocol analyses were performed. Data were subject to quality control. Results: Overall, 500 patients included in the Hp-EuReg were treated with rifabutin (mean age 52 years, 72% female, 63% with dyspepsia, 4% with peptic ulcer). Culture was performed in 63% of cases: dual resistance (to both clarithromycin and metronidazole) was reported in 46% of the cases, and triple resistance (to clarithromycin, metronidazole, and levofloxacin) in 39%. In 87% of cases rifabutin was utilised as part of a triple therapy together with amoxicillin and a proton-pump-inhibitor, and in an additional 6% of the patients, bismuth was added to this triple regimen. Rifabutin was mainly used in second-line (32%), third-line (25%), and fourth-line (27%) regimens, achieving overall 78%, 80% and 66% effectiveness by modified intention-to-treat, respectively. Compliance with treatment was 89%. At least one adverse event was registered in 26% of the patients (most frequently nausea), and one serious adverse event (0.2%) was reported in one patient with leukopenia and thrombocytopenia with fever requiring hospitalisation. Conclusion: Rifabutin-containing therapy represents an effective and safe strategy after one or even several failures of H. pylori eradication treatment.

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