Commentary: Helicobacter pylori eradication in Western Australia
Article first published online: 4 DEC 2012
© 2012 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 37, Issue 1, page 158, January 2013
How to Cite
Tehami, N. A. and Nwokolo, C. U. (2013), Commentary: Helicobacter pylori eradication in Western Australia. Alimentary Pharmacology & Therapeutics, 37: 158. doi: 10.1111/apt.12129
- Issue published online: 4 DEC 2012
- Article first published online: 4 DEC 2012
- Manuscript Received: 16 OCT 2012
- Manuscript Accepted: 16 OCT 2012
Despite the success of the Maastricht triple regimens their inherent 20% failure rate leaves a rump of patients still colonised by the bacterium. When cure has failed many patients (and their physicians) become obsessed and innumerable regimens are explored. Many designed illogically, result in failure leaving behind increased antibiotic resistance in the general population and even more dissatisfied patients. Interest in this subject is reflected by the number of papers published in the last 12 months.[2-4]
This current article by Tay et al. reports the remarkable success of two H. pylori cure regimens in patients who had mostly received two triple regimens. Both regimens include rifabutin and ciprofloxacin and it is alarming that HP resistance to these antibiotics already exist although stable resistance rates between 2007 and 2011 may give some comfort.
Both regimens use rabeprazole 20 mg t.d.s. to increase intra-gastric pH and enhance the performance of the antibiotics in the gastric milieu. Sugimoto et al. report that Rabeprazole 10 mg q.d.s. may be even more effective in this role. The more frequent dosing regimen of rabeprazole should not be too burdensome given that the proton pump inhibitor, bismuth subcitrate, rifabutin and ciprofloxacin (PBRC) regimen already includes bismuth subcitrate taken q.d.s. and the proton pump inhibitor, amoxycillin, rifabutin, ciprofloxacin (PARC) regimen includes amoxycillin taken t.d.s. Furthermore, these patients are usually highly motivated and will comply if there is a good chance of cure.
It is not clear why the rifabutin and ciprofloxacin are for the last 5 days in the PARC regimen and why the dose and duration of rifabutin are doubled in the PBRC regimen.
That these regimens perform well even when H. pylori antibiotic resistance is unknown is important as most Gastroenterologists do not have this facility. These regimens are a welcome addition to the armamentarium of practicing Physicians wanting to treat this small but important group of patients.
Declaration of personal and funding interests: None.