Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain.
Aliment Pharmacol Ther. 2012 Jan;35(2):209-21. doi: 10.1111/j.1365-2036.2011.04937.x. Epub 2011 Nov 30.
Even with the current most effective treatment regimens, a relevant proportion of patients will fail to eradicate Helicobacter pylori infection.
To evaluate the role of rifabutin in the treatment of H. pylori infection.
Bibliographical searches were performed in MEDLINE. Data on the efficacy of rifabutin-containing regimens on H. pylori eradication were combined and meta-analysed using the generic inverse variance method.
Rifabutin shows good in vitro activity against H. pylori. Mean H. pylori rifabutin resistance rate (calculated from 11 studies including 2982 patients) was 1.3% (95% confidence interval = 0.9-1.7%). When only studies including patients naïve to H. pylori eradication treatment were considered, this figure was even lower (0.6%). On the other hand, higher values of rifabutin resistance were calculated (1.59%) when only post-treatment patients were considered. Overall, mean H. pylori eradication rate (intention-to-treat analysis) with rifabutin-containing regimens (1008 patients) was 73% (67-79%). Respective cure rates for second-line (223 patients), third-line (342 patients) and fourth/fifth-line (95 patients) rifabutin therapies were 79% (67-92%), 66% (55-77%) and 70% (60-79%) respectively. For treating H. pylori infection, almost all studies have administered rifabutin 300 mg/day; this dose seems to be more effective than 150 mg/day. The ideal length of treatment remains unclear, but 10- to 12-day regimens are generally recommended. The mean rate of adverse effects was 22% (19-25%). Myelotoxicity is the most significant, although this complication was rare. Until now, all patients have recovered of leucopenia uneventfully in a few days, and there have been no reports of infection or other adverse outcomes related to it.
Rifabutin-containing rescue therapy constitutes an encouraging strategy after multiple (usually three) previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline and levofloxacin.
即使采用目前最有效的治疗方案，仍有相当一部分患者无法根除幽门螺杆菌感染。
评估利福布汀在幽门螺杆菌感染治疗中的作用。
在 MEDLINE 中进行文献检索。对包含利福布汀方案治疗幽门螺杆菌根除的疗效数据进行合并，并采用通用倒数方差法进行荟萃分析。
利福布汀对幽门螺杆菌具有良好的体外活性。幽门螺杆菌利福布汀耐药率平均值（来自包括 2982 例患者的 11 项研究计算得出）为 1.3%（95%置信区间为 0.9-1.7%）。当仅考虑对幽门螺杆菌根除治疗无经验的患者时，这一数值更低（0.6%）。另一方面，当仅考虑治疗后患者时，计算出的利福布汀耐药率更高（1.59%）。总体而言，含利福布汀方案的幽门螺杆菌根除率（意向治疗分析）为 73%（67-79%）。二线（223 例）、三线（342 例）和四线/五线（95 例）利福布汀治疗的治愈率分别为 79%（67-92%）、66%（55-77%）和 70%（60-79%）。对于治疗幽门螺杆菌感染，几乎所有研究均采用 300mg/天的利福布汀剂量；该剂量似乎比 150mg/天更有效。理想的治疗时间尚不清楚，但通常推荐 10-12 天的疗程。不良反应的平均发生率为 22%（19-25%）。骨髓毒性是最显著的，但这种并发症很少见。到目前为止，所有患者的白细胞减少症均在数天内自行恢复，且无感染或其他与之相关的不良结局的报告。
在阿莫西林、克拉霉素、甲硝唑、四环素和左氧氟沙星等关键抗生素多次（通常为 3 次）根除失败后，含利福布汀的补救治疗构成了一种令人鼓舞的策略。
