Review article: rifabutin in the treatment of refractory Helicobacter pylori infection

摘要: Aliment Pharmacol Ther 2012; 35: 209–221 Summary Background  Even with the current most effective treatment regimens, a relevant proportion of patients will fail to eradicate Helicobacter pylori infection. Aim  To evaluate role rifabutin in H. infection. Methods  Bibliographical searches were performed MEDLINE. Data on efficacy rifabutin-containing regimens eradication combined and meta-analysed using generic inverse variance method. Results  Rifabutin shows good vitro activity against pylori. Mean resistance rate (calculated from 11 studies including 2982 patients) was 1.3% (95% confidence interval = 0.9–1.7%). When only naive considered, this figure even lower (0.6%). On other hand, higher values calculated (1.59%) when post-treatment considered. Overall, mean (intention-to-treat analysis) (1008 73% (67–79%). Respective cure rates for second-line (223 patients), third-line (342 fourth/fifth-line (95 therapies 79% (67–92%), 66% (55–77%) 70% (60–79%) respectively. For treating infection, almost all have administered 300 mg/day; dose seems be more than 150 mg/day. The ideal length remains unclear, but 10- 12-day are generally recommended. adverse effects 22% (19–25%). Myelotoxicity is significant, although complication rare. Until now, recovered leucopenia uneventfully few days, there been no reports infection or outcomes related it. Conclusion  Rifabutin-containing rescue therapy constitutes an encouraging strategy after multiple (usually three) previous failures key antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline levofloxacin.