Sung Jihee, Kim Nayoung, Park Yo Han, Hwang Young Jae, Kwon Soohoon, Na Gyeongjae, Choi Joon Young, Kang Jae Bin, Kim Hye Rang, Kim Jin Wook, Lee Dong Ho
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Korean J Gastroenterol. 2017 Feb 25;69(2):109-118. doi: 10.4166/kjg.2017.69.2.109.
BACKGROUND/AIMS: Optimized regimen has not yet been established for failures of multiple () eradication. Hence, we aimed to evaluate the efficacy of rifabutin-based rescue therapy, at least after three eradication failures.
Twelve patients, who failed in the treatment for eradication at least three times, were consecutively enrolled between 2007 and 2015 at Seoul National University Bundang Hospital. The rifabutin-based rescue regimen was consisted of proton pump inhibitor (PPI), rifabutin (150 mg b.i.d.), and amoxicillin (1 g b.i.d.), given for 7 or 14 days. MIC concentration test by the agar dilution method was performed on six patients prior to rifabutin-based rescue therapy.
One patient did not take this regimen, and per-protocol (PP) analysis was performed in 11 patients. The overall eradication rate by intention-to-treat and PP analysis with rifabutin-based rescue therapy was 50.0% (6/12 patients) and 54.5% (6/11 patients), respectively. There was no difference of the eradication rate depending on the underlying disease, smoking, alcohol, number of previous eradication failures, and CYP2C19 genotype. All of the six patients were susceptible to rifabutin, but only three of them succeeded in eradicating with . Side effects occurred in two patients (18.2%), and compliance was 90.9%.
Even the eradication rate of rifabutin-based rescue therapy was not very good. Rifabutin-based rescue therapy could be considered as a rescue therapy, perhaps as the fourth or the fifth-line treatment option. No correlation of rifabutin sensitivity with eradication success rate of suggests that frequent administration of high dose PPI and amoxicillin might be important.
背景/目的：针对多次根除幽门螺杆菌失败的情况，尚未确立优化的治疗方案。因此，我们旨在评估以利福布汀为基础的挽救治疗的疗效，至少在三次根除失败之后。
2007年至2015年期间，首尔国立大学盆唐医院连续纳入了12例至少三次根除幽门螺杆菌治疗失败的患者。以利福布汀为基础的挽救方案包括质子泵抑制剂（PPI）、利福布汀（150毫克，每日两次）和阿莫西林（1克，每日两次），疗程为7或14天。在以利福布汀为基础的挽救治疗前，对6例患者进行了琼脂稀释法的最低抑菌浓度（MIC）检测。
1例患者未采用该方案，对11例患者进行了符合方案（PP）分析。基于意向性分析和PP分析，以利福布汀为基础的挽救治疗的总体根除率分别为50.0%（6/12例患者）和54.5%（6/11例患者）。根除率在基础疾病、吸烟、饮酒、既往根除失败次数和CYP2C19基因型方面没有差异。6例患者对利福布汀均敏感，但其中只有3例成功根除幽门螺杆菌。2例患者（18.2%）出现了副作用，依从性为90.9%。
即使以利福布汀为基础的挽救治疗的根除率不是很好。以利福布汀为基础的挽救治疗可被视为一种挽救治疗方法，或许作为第四或第五线治疗选择。利福布汀敏感性与幽门螺杆菌根除成功率之间无相关性，提示频繁给予高剂量PPI和阿莫西林可能很重要。
