Ribaldone Davide Giuseppe, Fagoonee Sharmila, Astegiano Marco, Durazzo Marilena, Morgando Anna, Sprujevnik Tatiana, Giordanino Chiara, Baronio Monica, De Angelis Claudio, Saracco Giorgio Maria, Pellicano Rinaldo
Department of Surgical Sciences, University of Turin, 10123 Turin, Italy.
Institute of Biostructure and Bioimaging (CNR) c/o Molecular Biotechnology Center, 10126 Turin, Italy.
J Clin Med. 2019 Feb 6;8(2):199. doi: 10.3390/jcm8020199.
The most commonly used regimens fail to eradicate () infection in 5⁻10% of patients. Those not cured with treatments based on amoxicillin, clarithromycin, nitroimidazoles, fluoroquinolones, bismuth or tetracycline have no other conventional options thereafter. In this prospective long-term monocentric study, patients who failed to eradicate following treatment with all conventional antibiotics were included. All subjects were treated with rifabutin 150 mg, amoxicillin 1 g and a standard dose of proton pump inhibitor, twice daily for 14 days. A negative C-urea breath test was used four weeks after treatment completion as an index of eradication. Three hundred and two patients were included. Fifty-four percent (164/302) had peptic ulcer disease while 45.7% (138/302) had gastritis or functional dyspepsia. Per-protocol eradication and intention-to-treat eradication were achieved in 72.7% and 71.5%, respectively. A univariate analysis showed that gender, ethnic background, smoking habits and familial history of gastric diseases were not predictive factors of response, while with multiple logistic regression analysis, the ethnic background (Italian) predicted a poor response in the second period of the study (2010⁻2017). In conclusion, this study on a large cohort of very difficult-to-treat patients showed that rifabutin-based rescue therapy is an acceptable and safe strategy after multiple eradication failures with conventional antibiotics.
最常用的治疗方案在5%至10%的患者中无法根除（）感染。那些使用基于阿莫西林、克拉霉素、硝基咪唑类、氟喹诺酮类、铋剂或四环素的治疗方法未治愈的患者，此后没有其他常规选择。在这项前瞻性长期单中心研究中，纳入了使用所有常规抗生素治疗后仍未能根除（）的患者。所有受试者均接受利福布汀150毫克、阿莫西林1克和标准剂量质子泵抑制剂治疗，每日两次，共14天。治疗结束四周后，采用阴性C-尿素呼气试验作为根除（）的指标。共纳入302例患者。54%（164/302）患有消化性溃疡疾病，而45.7%（138/302）患有胃炎或功能性消化不良。符合方案分析的根除率和意向性分析的根除率分别为72.7%和71.5%。单因素分析显示，性别、种族背景、吸烟习惯和胃部疾病家族史不是反应的预测因素，而多因素逻辑回归分析显示，种族背景（意大利人）在研究的第二阶段（2010 - 2017年）预测反应较差。总之，这项针对大量极难治疗患者的研究表明，在常规抗生素多次根除失败后，基于利福布汀的挽救治疗是一种可接受且安全的策略。
