The effectiveness of rifabutin triple therapy for patients with difficult‐to‐eradicate Helicobacter pylori in clinical practice

Summary Background Failure of first line and subsequent Helicobacter pylori eradication therapy is a significant problem and alternative treatments are few. Aims To evaluate the efficacy of a rifabutin‐based triple therapy in clinical practice and determine the optimal strategy for its use. Methods Patients referred after first or subsequent treatment failure were prescribed rifabutin triple therapy consisting of standard dose proton pump inhibitor, amoxicillin 1 g and rifabutin 150 mg each b.d. for 10 days. Results In 67 patients, the main indications for treatment were dyspepsia (55%), peptic ulcer disease (24%) and increased gastric cancer risk (18%). The median number of previous treatments was 2 (range: 1–9). Eradication of Helicobacter pylori was achieved in 76% (48/63) per protocol and 72% (48/67) on an intention‐to‐treat basis. When used as second line therapy, 95% (18/19) achieved eradication compared with 68% (30/44) when two or more previous treatments had been used ( P = 0.03). Outcome was independent of age, ethnicity, gender or indication for treatment. Adverse events were reported in 10%. Conclusion Rifabutin triple therapy is a well tolerated and effective second line therapy in the treatment of persistent Helicobacter pylori; however, its efficacy decreases with increasing number of failed previous therapies.