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Rifabutin added to combination therapy might be a new option for treating H. pylori infection

Question clinique

Can a rifabutin-based treatment eliminate Helicobacter pylori infections?

L’Essentiel

Rifabutin (Mycobutin), an antimycobacterial, is effective when added to a proton-pump inhibitor and amoxicillin to eradicate Helicobacter pylori in approximately 80% of patients. 1b

Référence

Graham DY, Canaan Y, Maher J, et al. Rifabutin-based triple therapy (RHB-105) for Helicobacter pylori eradication. A double-blind, randomized, controlled trial. Ann Intern Med 2020;172:795-802.

Plan de l'etude: Randomized controlled trial (double-blinded)

Financement: Industry

Cadre: Outpatient (any)

Sommaire

The authors enrolled 455 adults with dyspepsia for at least 2 weeks and a confirmed H. pylori infection. Interesting (at least to me): The authors did not report the percent of patients who received a nonsteroidal anti-inflammatory drug. The patients were randomized, using concealed allocation, to receive eradication treatment with either amoxicillin 3 g and omeprazole 120 mg daily or that combination plus rifabutin 150 mg, each given in 3 doses daily for 14 days. Using intention-to-treat analysis, H. pylori eradication occurred in 83.8% of the rifabutin-added group as compared with 57.7% of the group treated with amoxicillin as the sole antibiotic (P < .001). Neither group received bismuth, and the single antibiotic comparison is a bit of a straw man. We need comparisons with other combinations to really determine the benefit of rifabutin.

Reviewer

Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA


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Commentaires

Alan Kenneth Macklem

H pylori eradication.

I agree that was not a valid comparison. Also what does this drug cost. Many of my patients can't afford much.

octobre 2, 2020
Anonymous

Rifabutin

Learned something new

octobre 6, 2020
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