This uncommissioned review article was subject to full peer-review.
Review article: rifabutin in the treatment of refractory Helicobacter pylori infection
Article first published online: 30 NOV 2011
© 2011 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 35, Issue 2, pages 209–221, January 2012
How to Cite
Gisbert, J. P. and Calvet, X. (2012), Review article: rifabutin in the treatment of refractory Helicobacter pylori infection. Alimentary Pharmacology & Therapeutics, 35: 209–221. doi: 10.1111/j.1365-2036.2011.04937.x
- Issue published online: 15 DEC 2011
- Article first published online: 30 NOV 2011
- Publication data Submitted 19 September 2011 First decision 4 November 2011 Resubmitted 5 November 2011 Accepted 10 November 2011 EV Pub Online 30 November 2011
Aliment Pharmacol Ther 2012; 35: 209–221
Background Even with the current most effective treatment regimens, a relevant proportion of patients will fail to eradicate Helicobacter pylori infection.
Aim To evaluate the role of rifabutin in the treatment of H. pylori infection.
Methods Bibliographical searches were performed in MEDLINE. Data on the efficacy of rifabutin-containing regimens on H. pylori eradication were combined and meta-analysed using the generic inverse variance method.
Results Rifabutin shows good in vitro activity against H. pylori. Mean H. pylori rifabutin resistance rate (calculated from 11 studies including 2982 patients) was 1.3% (95% confidence interval = 0.9–1.7%). When only studies including patients naïve to H. pylori eradication treatment were considered, this figure was even lower (0.6%). On the other hand, higher values of rifabutin resistance were calculated (1.59%) when only post-treatment patients were considered. Overall, mean H. pylori eradication rate (intention-to-treat analysis) with rifabutin-containing regimens (1008 patients) was 73% (67–79%). Respective cure rates for second-line (223 patients), third-line (342 patients) and fourth/fifth-line (95 patients) rifabutin therapies were 79% (67–92%), 66% (55–77%) and 70% (60–79%) respectively. For treating H. pylori infection, almost all studies have administered rifabutin 300 mg/day; this dose seems to be more effective than 150 mg/day. The ideal length of treatment remains unclear, but 10- to 12-day regimens are generally recommended. The mean rate of adverse effects was 22% (19–25%). Myelotoxicity is the most significant, although this complication was rare. Until now, all patients have recovered of leucopenia uneventfully in a few days, and there have been no reports of infection or other adverse outcomes related to it.
Conclusion Rifabutin-containing rescue therapy constitutes an encouraging strategy after multiple (usually three) previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline and levofloxacin.