Su1175 Fourth-Line Rescue Therapy With Rifabutin in Patients With Three H. pylori Eradication Failures

BODY: BACKGROUND: In some cases, Helicobater pylori infection persists even after 3 eradication treatments. AIM: To evaluate the efficacy of an empirical forth-line rescue regimen with rifabutin in patients with 3 eradication failures, extending the experience of an ongoing multicenter study. METHODS: Design: Multicenter, prospective study. Patients: Patients in whom the following 3 eradication treatments had consecutively failed: 1st treatment: PPI + clarithromycin + amoxicillin; 2nd treatment: quadruple therapy (PPI + bismuth + tetracycline + metronidazole); 3rd treatment: PPI + amoxicillin + levofloxacin. Intervention: In patients failing these 3 regimens, a 4th regimen with rifabutin (150 mg b.i.d.), amoxicillin (1 g b.i.d.) and a PPI (standard dose b.i.d.) was prescribed for 10 days. Outcome: Eradication was confirmed using the 13C-urea breath test 4-8 weeks after therapy. Compliance and tolerance: Compliance was determined through questioning and recovery of emptymedication envelopes. Incidence of adverse effects was evaluated by means of a questionnaire. RESULTS: One-hundred and twenty-one patients (mean age 50 years, 41% males, 27% peptic ulcer/ 73% functional dyspepsia) were included. Compliance: 8 patients did not take correctly the medication (in 6 cases due to adverse effects). Per-protocol and intention-to-treat eradication rates were 54% (95%CI=44-64%) and 52% (43-61%). Adverse effects were reported in 40 S-334 AGA Abstracts (33%) patients, the most frequent being: nausea/vomiting (severe in 2 patients), asthenia/ anorexia, abdominal pain, diarrhea, fever, metallic taste, myalgia, hypertransaminasemia, leucopoenia (,1,500 neutrophils), thrombopoenia (,150,000 platelets), headache, and aphthous stomatitis. Myelotoxicity resolved spontaneously in all cases. CONCLUSION: Even after 3 previous H. pylori eradication failures, an empirical fourth-line rescue treatment with rifabutin may be effective in approximately 50% of the cases. Therefore, rifabutinbased rescue therapy constitutes a valid strategy after multiple previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline, and levofloxacin.