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Efficacy of and Resistance to Rifaximin-based Quadruple Therapy in Helicobacter pylori Eradication

김현수, 윤혁, 신동우, 오동준, 권민구, 최윤진, 신철민, 박영수, 김나영, 이동호,
소속 상세정보
김현수 ( Kim Hyun-Soo ) - Seoul National University Bundang Hospital Department of Internal Medicine
윤혁 ( Yoon Hyuk ) - Seoul National University Bundang Hospital Department of Internal Medicine
신동우 ( Shin Dong-Woo ) - Seoul National University Bundang Hospital Department of Internal Medicine
오동준 ( Oh Dong-Jun ) - Seoul National University Bundang Hospital Department of Internal Medicine
권민구 ( Kwon Min-Gu ) - Seoul National University Bundang Hospital Department of Internal Medicine
최윤진 ( Choi Yoon-Jin ) - Seoul National University Bundang Hospital Department of Internal Medicine
신철민 ( Shin Cheol-Min ) - Seoul National University Bundang Hospital Department of Internal Medicine
박영수 ( Park Young-Soo ) - Seoul National University Bundang Hospital Department of Internal Medicine
김나영 ( Kim Na-Young ) - Seoul National University Bundang Hospital Department of Internal Medicine
이동호 ( Lee Dong-Ho ) - Seoul National University Bundang Hospital Department of Internal Medicine

Abstract


Background/Aims: The treatment options for Helicobacter pylori (H. pylori) infection are in a state of flux: traditional triple therapies have started to fail, and new treatments are unable to achieve optimal eradication rates. Rifaximin and rifabutin are new antibiotics. The aim of this study was to evaluate the efficacy and safety of adding rifaximin to the standard triple regimen and of a rifabutin-based triple regimen as a rescue therapy for H. pylori eradication.

Materials and Methods: We enrolled 27 H. pylori-positive patients who were treated with a proton pump inhibitor, amoxicillin, clarithromycin, and rifaximin for 14 days. H. pylori eradication was assessed by a 13C-urea breath test performed 4 weeks after therapy completion. The efficacy of the therapy was based on intention-to-treat (ITT) and per-protocol (PP) analysis. We also investigated the resistance rate, compliance, and side effects associated with rifaximin therapy. Minimal inhibitory concentrations and resistance to rifabutin were evaluated using the agar dilution method.

Results: Of the 27 patients, 22 completed the treatment protocol with 100% compliance; five patients withdrew. The ITT and PP eradication rates for the rifaximin-containing quadruple therapy were 70.4% (19/27) and 86.3% (19/22), respectively. Adverse events were observed in five of 22 patients (22.7%). The resistance rates to rifaximin and rifabutin were 66.7% (2/3) and 0% (0/3), respectively.

Conclusions: The findings of this study show the limitations of rifaximin-based quadruple therapy and suggest the benefits of a rifabutin-based rescue regimen in South Korea.

키워드

Amoxicillin; Clarithromycin; Helicobacter pylori; Rifaximin

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