The effectiveness of rifabutin triple therapy for patients with difficult-to-eradicate Helicobacter pylori in clinical practice

Aliment Pharmacol Ther. 2007 Dec;26(11-12):1537-42. doi: 10.1111/j.1365-2036.2007.03531.x. Epub 2007 Sep 28.


Background: Failure of first line and subsequent Helicobacter pylori eradication therapy is a significant problem and alternative treatments are few.

Aims: To evaluate the efficacy of a rifabutin-based triple therapy in clinical practice and determine the optimal strategy for its use.

Methods: Patients referred after first or subsequent treatment failure were prescribed rifabutin triple therapy consisting of standard dose proton pump inhibitor, amoxicillin 1 g and rifabutin 150 mg each b.d. for 10 days.

Results: In 67 patients, the main indications for treatment were dyspepsia (55%), peptic ulcer disease (24%) and increased gastric cancer risk (18%). The median number of previous treatments was 2 (range: 1-9). Eradication of Helicobacter pylori was achieved in 76% (48/63) per protocol and 72% (48/67) on an intention-to-treat basis. When used as second line therapy, 95% (18/19) achieved eradication compared with 68% (30/44) when two or more previous treatments had been used (P = 0.03). Outcome was independent of age, ethnicity, gender or indication for treatment. Adverse events were reported in 10%.

Conclusion: Rifabutin triple therapy is a well tolerated and effective second line therapy in the treatment of persistent Helicobacter pylori; however, its efficacy decreases with increasing number of failed previous therapies.

MeSH terms

  • Adult
  • Aged
  • Amoxicillin / administration & dosage*
  • Amoxicillin / adverse effects
  • Drug Therapy, Combination
  • Female
  • Helicobacter Infections / drug therapy*
  • Helicobacter pylori / drug effects*
  • Humans
  • Male
  • Middle Aged
  • Ofloxacin / administration & dosage
  • Prospective Studies
  • Proton Pump Inhibitors / administration & dosage*
  • Proton Pump Inhibitors / adverse effects
  • Rifabutin / administration & dosage*
  • Rifabutin / adverse effects


  • Proton Pump Inhibitors
  • Rifabutin
  • Amoxicillin
  • Ofloxacin