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World J Gastroenterol. Dec 7, 2022; 28(45): 6356-6362
Published online Dec 7, 2022. doi: 10.3748/wjg.v28.i45.6356
Rifabutin as salvage therapy for Helicobacter pylori eradication: Cornerstones and novelties
Antonia Valeria Borraccino, Francesca Celiberto, Maria Pricci, Bruna Girardi, Andrea Iannone, Maria Rendina, Enzo Ierardi, Alfredo Di Leo, Giuseppe Losurdo
Antonia Valeria Borraccino, Francesca Celiberto, Andrea Iannone, Maria Rendina, Enzo Ierardi, Alfredo Di Leo, Giuseppe Losurdo, Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
Maria Pricci, Bruna Girardi, THD SpA, Correggio 42015, Italy
Author contributions: Losurdo G and Di Leo A planned the investigation; Borraccino AV and Celiberto F carried out the research; Borraccino AV, Losurdo G, and Ierardi E wrote the paper; Di Leo A supervised the study; and all authors read and validated the final version.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Giuseppe Losurdo, MD, Assistant Professor, Doctor, Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, Bari 70124, Italy. giuseppelos@alice.it
Received: September 17, 2022
Peer-review started: September 17, 2022
First decision: October 19, 2022
Revised: October 25, 2022
Accepted: November 17, 2022
Article in press: November 17, 2022
Published online: December 7, 2022
Abstract

When several Helicobacter pylori eradication treatments fail, guidelines recommend a cultured guided approach; however, culture is not widely available. Therefore, a rifabutin based regimen could be the best solution. Rifabutin indeed shows a low rate of antibiotic resistance. Rifabutin is generally used in combination with amoxicillin in a triple therapy, with eradication rates about 80% in third-line regimens. The ideal duration of this therapy should range between 10 and 12 d. Combinations with antibiotics other than amoxicillin have demonstrated even better results, such as vonoprazan, which is a type of novel acid suppressor drug. Finally, a new formulation of triple therapy in a single capsule is under investigation, which is a field that deserves further investigation. Some notes of caution about rifabutin should be mentioned. This drug is used to treat tuberculosis or atypical mycobacteria; therefore, before starting a rifabutin-based eradication regimen, Mycobacterium tuberculosis infection should be thoroughly tested, since its use could promote the development of antibiotic resistance, thus affecting its effectiveness against Koch’s bacillus. Additionally, some serious side effects must be evaluated before starting any rifabutin-based therapy. Adverse effects include fever, nausea, vomiting and bone marrow suppression. For this reason, full blood count surveillance is required.

Keywords: Helicobacter pylori, Eradication, Rifabutin, Antibiotic resistance, Rescue therapy, Treatment

Core Tip: Rifabutin is an antibiotic that is commonly used to treat tuberculosis or atypical mycobacteria. However, it shows antimicrobial effect against Helicobacter pylori as well. It is indicated when multiple eradication treatments have failed. In this review, we summarized current evidence about traditional triple therapy containing amoxicillin and rifabutin as salvage therapy, based on the most recent meta-analyses. Furthermore, other novelties regarding rifabutin based regimens have been mentioned.