Highlights
- •A decreasing trend in the efficacy of rifabutin-based therapy was detected, particularly when clarithromycin resistance was present.
- •Our data confirm Pylera® regimen as a reliable option to successfully treat eradication failure patients. Indeed, the eradication rates are steadily high (90%) until the fourth-line attempt.
- •These findings would suggest that the role of rifabutin-based regimen as rescue therapy should be at least reconsidered, and its use reserved to selected patients.
- •Unfortunately, Pylera® regimen is really complex and causes side-effects more frequently than other therapies.
Abstract
Background/Aims
H. pylori treatment remains a challenge for clinicians, and a definite quote of patients require
two or more treatments. We evaluated the efficacy of rifabutin-based therapy and Pylera®
regimen as rescue therapies.
Methods
Between January 2016 and December 2019, dyspeptic patients with at least one therapeutic
failure observed in clinical practice received either a 12-day rifabutin-based triple
therapy (esomeprazole 40 mg and amoxicillin 1 g, both twice daily, and rifabutin 150 mg
once daily) or 10-day quadruple therapy with Pylera® (three in one capsule containing
140 mg bismuth subcitrate potassium, 125 mg metronidazole and 125 mg tetracycline).
The eradication rates according to previous number of eradication failure therapies
were calculated. The role antibiotic resistance pattern in H. pylori isolates was also investigated.
Results
Data of 423 patients were available. A total of 270 patients were treated with rifabutin-based
therapy, and the overall eradication rate was 61.9%. Pylera® therapy was administered
to 153 patients and the cure rate was 88.3%. According to the number of previous therapeutic
failures, the eradication rate for the rifabutin-based therapy was 68.3% as second-line
and further decreased to 63.1% in fourth-line therapy. Following Pylera® regimen,
the cure rate was 94.8% in second-line, and remained 89.6% in fourth-line therapy.
Efficacy of rifabutin-based and Pylera® therapies significantly decreased when clarithromycin
and levofloxacin resistance, respectively, were present.
Conclusions
Our data documented a decreasing trend for rifabutin-based therapy efficacy according
to previous therapy failures, whilst this did not occur for Pylera®.
Keywords
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Article info
Publication history
Published online: July 06, 2020
Accepted:
June 25,
2020
Received in revised form:
June 16,
2020
Received:
April 23,
2020
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
