Evaluating treatments with rifabutin and amoxicillin for eradication of Helicobacter pylori infection in adults: a systematic review

ABSTRACT

Introduction

Helicobacter pylori causes dyspepsia, peptic ulcer, and gastric malignancies. Treatments for Helicobacter pylori are mostly empirical depending on regional antibiotic resistances and the patient’s history and less frequently susceptibility guided. Helicobacter pylori has a low resistance to rifabutin and has been proposed as an alternative for third-line treatment and beyond but recently has also gained attention for use as first- and second-line treatment.

Areas Covered

In this review, the authors systematically searched medical databases in order to present the current eradication rates for any treatment based on the two antibiotics, rifabutin and amoxicillin with a potent acid inhibitor. They also assessed the safety and tolerance of all the relative regimens.

Expert opinion

Treatment with a rifabutin- and amoxicillin-containing regimen is a valuable option when treating difficult to eradicate Helicobacter pylori infections. Its efficacy is overall 71.4%, and it is not influenced by previous antibiotics, gender, smoking habits, and age. Its results were better when used as a first- or second-line treatment. In third-line therapy and beyond, eradication rates are lower. Adverse effects of all rifabutin regimens occurred in 23% of patients and were mostly mild with bone marrow suppression being very low and reversible.

KEYWORDS:

• Helicobacter pylori
• rifabutin
• amoxicillin
• treatment of Helicobacter pylori

Article highlights

• Helicobacter pylori is a key pathogen for gastric diseases, and treatment is necessary.

• Current treatments for Helicobacter pylori are mostly empirical although susceptibility-guided therapy has been proposed by some authorities to follow the rules of good antibiotic stewardship.

• The key antibiotics like clarithromycin, metronidazole, and quinolones have increasing resistances leading in first- and second-line treatment failures.

• Rifabutin is a very potent antibiotic against Helicobacter pylori, and it has a very low resistance rate.

• Currently, treatments with rifabutin and amoxicillin are being used for third-line treatment and beyond with poor results.

• Besides, there is ample evidence to support the use of those regimens as first- and second-line treatments with acceptable cure rates much better than when used as third-line treatment and beyond.

• Several optimization strategies for rifabutin-based regimens are promising but need to be further evaluated.

• Adherence is good, and adverse effects have been reported in at least 7% of the patients treated with a rifabutin-based regimen. Some of them can be severe such as hepatitis and neutropenia.

Disclosure statement

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in this manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This manuscript was not funded.