Abstract:
BACKGROUND:In some cases, Helicobacter pylori infection persists even after three eradication treatments. AIM:To evaluate the efficacy of an empirical fourth-line rescue regimen with rifabutin in patients with three eradication failures. METHODS: DESIGN:Multicentre, prospective study. PATIENTS:In whom the following three treatments had consecutively failed: first (PPI + clarithromycin + amoxicillin); second (PPI + bismuth + tetracycline + metronidazole); third (PPI + amoxicillin + levofloxacin). INTERVENTION:A fourth regimen with rifabutin (150 mg b.d.), amoxicillin (1 g b.d.) and a PPI (standard dose b.d.) was prescribed for 10 days. OUTCOME:Eradication was confirmed by (13) C-urea breath test 4-8 weeks after therapy. Compliance and tolerance: Compliance was determined through questioning and recovery of empty medication envelopes. Adverse effects were evaluated using a questionnaire. RESULTS:One-hundred patients (mean age 50 years, 39% men, 31% peptic ulcer/69% functional dyspepsia) were included. Eight patients did not take the medication correctly (in six cases due to adverse effects). Per-protocol and intention-to-treat eradication rates were 52% (95% CI = 41-63%) and 50% (40-60%). Adverse effects were reported in 30 (30%) patients: nausea/vomiting (13 patients), asthenia/anorexia (8), abdominal pain (7), diarrhoea (5), fever (4), metallic taste (4), myalgia (4), hypertransaminasemia (2), leucopenia (<1,500 neutrophils) (2), thrombopenia (<150,000 platelets) (2), headache (1) and aphthous stomatitis (1). Myelotoxicity resolved spontaneously in all cases. CONCLUSIONS:Even after three previous H. pylori eradication failures, an empirical fourth-line rescue treatment with rifabutin may be effective in approximately 50% of the cases. Therefore, rifabutin-based rescue therapy constitutes a valid strategy after multiple previous eradication failures with key antibiotics, such as clarithromycin, metronidazole, tetracycline and levofloxacin.
journal_name
Aliment Pharmacol Therjournal_title
Alimentary pharmacology & therapeuticsauthors
Gisbert JP,Castro-Fernandez M,Perez-Aisa A,Cosme A,Molina-Infante J,Rodrigo L,Modolell I,Cabriada JL,Gisbert JL,Lamas E,Marcos E,Calvet Xdoi
10.1111/j.1365-2036.2012.05053.xsubject
Has Abstractpub_date
2012-04-01 00:00:00pages
941-7issue
8eissn
0269-2813issn
1365-2036journal_volume
35pub_type
杂志文章,多中心研究abstract:BACKGROUND:Despite the close relationship between primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD), the association between colectomy and the prognosis of PSC remains controversial. AIM:To explore whether colectomy prior to PSC-diagnosis is associated with transplant-free survival. METHODS:A ...
journal_title:Alimentary pharmacology & therapeutics
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journal_title:Alimentary pharmacology & therapeutics
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2000-03-01 00:00:00
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更新日期:2019-08-01 00:00:00