Rescue therapy with rifabutin regimen for refractory Helicobacter pylori infection with dual drug-resistant strains

Abstract Background: There is no current standard rescue treatment for dual drug-resistant strains of Helicobacter pylori. This aim of this study was to investigate the efficacy of rifabutin-based triple therapy for patients infected with dual drug-resistant strains to clarithromycin and levofloxacin.Methods: After two or three H. pylori treatment failures, patients underwent upper endoscopy with tissue biopsies. Phenotypic and genotypic resistance was determined using agar dilution test and polymerase chain reaction with direct sequencing, respectively. Patients infected with dual drug-resistant (clarithromycin and levofloxacin) strains and received rifabutin based triple therapy (rifabutin 150 mg bid, amoxicillin 1 g bid and esomeprazole 40 mg bid for 10 days) were enrolled. Eradication status was determined by 13C-urea breath test four weeks after treatment completion. Results: A total of 39 patients infected with dual drug-resistant strains were enrolled in this study, with a mean age of 55.9 years. The eradication rate was 79.5% (31/39). Adverse event was reported in 23.1% (9/39) of patients but mild and tolerable. In univariate analysis, no factor was identiﬁed as an independent predictor of eradication failure. Conclusions: Our current study demonstrated that rifabutin-based triple therapy was well tolerated and yielded an acceptable eradication rate for patients infected with dual drug-resistant strains of H. pylori.

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Helicobacter pylori Accumulates Photoactive Porphyrins and Is Killed by Visible Light

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.49.7.2822-2827.2005 ◽

2005 ◽

Vol 49 (7) ◽

pp. 2822-2827 ◽

Cited By ~ 124

Author(s):

Michael R. Hamblin ◽

Jennifer Viveiros ◽

Changming Yang ◽

Atosa Ahmadi ◽

Robert A. Ganz ◽

...

Keyword(s):

Helicobacter Pylori ◽

Visible Light ◽

Propionibacterium Acnes ◽

Protoporphyrin Ix ◽

Human Stomach ◽

Drug Resistant ◽

Violet Light ◽

Resistant Strains ◽

H Pylori ◽

Drug Resistant Strains

ABSTRACT Helicobacter pylori colonizes the mucus layer of the human stomach and duodenum, causes chronic gastritis, gastric ulcer, and is a risk factor for gastric adenocarcinoma. There is a 20% failure rate in antibiotic therapy, which is increasingly due to antibiotic resistance and necessitates the search for alternative antimicrobial methods. We have discovered that H. pylori when cultured in liquid medium, accumulates significant quantities of coproporphyrin and protoporphyrin IX, both in the cells and secreted into the medium. These photoactive porphyrins lead to cell death (up to 5 logs) by photodynamic action upon illumination with low doses of visible light, with blue/violet light being most efficient. The degree of killing increases with the age of the culture and is greater than that found with Propionibacterium acnes (another bacterium known to be photosensitive due to porphyrin accumulation). Both virulent and drug-resistant strains are killed. The data suggest that phototherapy might be used to treat H. pylori infection in the human stomach.

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