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Canadian Journal of Gastroenterology
Volume 24, Issue 5, Pages 303-306
http://dx.doi.org/10.1155/2010/637908
Original Article

Rescue Therapy Using a Rifabutin-Based Regimen is Effective for Cure of Helicobacter pylori Infection

Sander Veldhuyzen van Zanten,1 Snehal Desai,2 Linda Best,3 Geraldine Cooper-Lesins,3 Dickran Malatjalian,4 David Haldane,3 and Kevork Peltekian2

1Division of Gastroenterology, University of Alberta, Edmonton Centre, Edmonton, Alberta, Canada
2Division of Gastroenterology, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
3Division of Infectious Diseases, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
4Department of Pathology, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada

Received 26 August 2009; Accepted 6 October 2009

Copyright © 2010 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

OBJECTIVE: To evaluate the efficacy of rescue therapy using rifabutin, amoxicillin and a proton pump inhibitor (PPI) in the eradication of Helicobacter pylori in patients who have failed at least one course of PPI-based triple therapy.

METHODS: The present study was a single-centre case series of 16 consecutive patients who had received at least one course of standard eradication therapy. Pretreatment evaluation included endoscopy with biopsies for histology and culture for H pylori infection. Treatment consisted of a one-week regimen containing a PPI twice daily, amoxicillin (A) 1 g twice daily and rifabutin (R) 300 mg once daily (PPI-AR). Post-treatment evaluation consisted of a repeat endoscopy with biopsy for histology and culture, or a validated urea breath test at least four weeks after treatment was completed. Pretreatment antibiotic susceptibility to metronidazole, clarithromycin and A was evaluated using a validated epsilometer test.

RESULTS: Of the 16 patients, four had previously received one course of triple therapy, 10 had received two courses and two had received more than two courses. The overall success rate of PPI-AR was 63% (10 of 16). Resistance to A was 0% (0 of 13), metronidazole 77% (10 of 13), clarithromycin 70% (seven of 10), and both metronidazole and clarithromycin 60% (six of 10). There was no correlation between resistance patterns and cure rate.

CONCLUSIONS: An R-containing regimen such as PPI-AR is a viable option as rescue therapy for H pylori infection.