Patologia Medica, AOU Careggi Hospital, Florence, Italy.
Expert Rev Gastroenterol Hepatol. 2012 Aug;6(4):437-9. doi: 10.1586/egh.12.32.
Helicobacter pylori represents the major cause of gastric cancer, gastric lymphoma and peptic ulcer diseases. In some cases, the infection persists even after three rounds of treatment. The evaluated article reports on the efficacy of an empirical multicenter, prospective fourth‑line rescue study with rifabutin in patients with three consecutive eradication failures. A total of 100 patients (31% peptic ulcer and 69% functional dyspepsia) were included to receive a fourth‑line with rifabutin (150 mg twice daily [b.i.d.]), amoxicillin (1 g b.i.d.) and a proton‑pump inhibitor (standard dose b.i.d.) for 10 days. The end point was H. pylori eradication, determined by (13)C-urea breath test 4-8 weeks after therapy. H. pylori eradication was achieved in approximately 50% of patients. Adverse events (mainly metallic taste, nausea and diarrhea) were reported in 30 patients. Thus, a fourth-line rifabutin-based rescue therapy constitutes a valid strategy after multiple previous H. pylori eradication failures with key antibiotics, such as clarithromycin, metronidazole, tetracycline and levofloxacin.
幽门螺杆菌是胃癌、胃淋巴瘤和消化性溃疡病的主要病因。在某些情况下，即使经过三轮治疗，感染仍会持续存在。评估的文章报告了一项经验性的、多中心的、前瞻性的四线挽救研究的疗效，该研究在连续三次根除失败的患者中使用利福布汀进行治疗。共有 100 名患者（31%为消化性溃疡，69%为功能性消化不良）接受了四线治疗，包括利福布汀（150mg，每日两次）、阿莫西林（1g，每日两次）和质子泵抑制剂（标准剂量，每日两次），共 10 天。治疗结束后 4-8 周，通过（13）C-尿素呼气试验来确定幽门螺杆菌的根除情况。约有 50%的患者实现了幽门螺杆菌的根除。30 名患者报告了不良反应（主要是金属味、恶心和腹泻）。因此，在先前使用关键抗生素（如克拉霉素、甲硝唑、四环素和左氧氟沙星）多次根除幽门螺杆菌失败后，基于利福布汀的四线挽救治疗是一种有效的策略。
