Department of Surgical and Medical Sciences, University of Bologna, Bologna, Italy.
Department of Surgical and Medical Sciences, University of Bologna, Bologna, Italy; Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.
Eur J Intern Med. 2020 Nov;81:50-53. doi: 10.1016/j.ejim.2020.06.029. Epub 2020 Jul 6.
BACKGROUND/AIMS: H. pylori treatment remains a challenge for clinicians, and a definite quote of patients require two or more treatments. We evaluated the efficacy of rifabutin-based therapy and Pylera® regimen as rescue therapies.
Between January 2016 and December 2019, dyspeptic patients with at least one therapeutic failure observed in clinical practice received either a 12-day rifabutin-based triple therapy (esomeprazole 40 mg and amoxicillin 1 g, both twice daily, and rifabutin 150 mg once daily) or 10-day quadruple therapy with Pylera® (three in one capsule containing 140 mg bismuth subcitrate potassium, 125 mg metronidazole and 125 mg tetracycline). The eradication rates according to previous number of eradication failure therapies were calculated. The role antibiotic resistance pattern in H. pylori isolates was also investigated.
Data of 423 patients were available. A total of 270 patients were treated with rifabutin-based therapy, and the overall eradication rate was 61.9%. Pylera® therapy was administered to 153 patients and the cure rate was 88.3%. According to the number of previous therapeutic failures, the eradication rate for the rifabutin-based therapy was 68.3% as second-line and further decreased to 63.1% in fourth-line therapy. Following Pylera® regimen, the cure rate was 94.8% in second-line, and remained 89.6% in fourth-line therapy. Efficacy of rifabutin-based and Pylera® therapies significantly decreased when clarithromycin and levofloxacin resistance, respectively, were present.
Our data documented a decreasing trend for rifabutin-based therapy efficacy according to previous therapy failures, whilst this did not occur for Pylera®.
背景/目的：幽门螺杆菌的治疗仍然是临床医生面临的挑战，确实有一定比例的患者需要进行两次或更多次治疗。我们评估了利福布汀为基础的治疗和 Pylera®方案作为补救治疗的疗效。
在 2016 年 1 月至 2019 年 12 月期间，接受至少一次临床实践中治疗失败的消化不良患者接受了为期 12 天的利福布汀三联疗法（埃索美拉唑 40mg 和阿莫西林 1g，均每日两次，和利福布汀 150mg，每日一次）或 10 天的 Pylera®四联疗法（三粒装胶囊，每粒含 140mg 枸橼酸铋钾、125mg 甲硝唑和 125mg 四环素）。根据以前的根除失败治疗次数计算根除率。还调查了 H. pylori 分离株中抗生素耐药模式的作用。
共 423 例患者的数据可用。共有 270 例患者接受了利福布汀为基础的治疗，总体根除率为 61.9%。153 例患者接受了 Pylera®治疗，治愈率为 88.3%。根据以前的治疗失败次数，利福布汀为基础的治疗根除率为二线治疗的 68.3%，进一步降至四线治疗的 63.1%。采用 Pylera®方案后，二线治疗的治愈率为 94.8%，四线治疗的治愈率仍为 89.6%。当克拉霉素和左氧氟沙星耐药时，利福布汀为基础的和 Pylera®治疗的疗效显著降低。
我们的数据记录了利福布汀为基础的治疗疗效根据以前的治疗失败呈下降趋势，而 Pylera®则没有发生这种情况。
