Rifabutin- and furazolidone-based Helicobacter pylori eradication therapies after failure of standard first- and second-line eradication attempts in dyspepsia patients ASGHAR QASIM, SHAJI SEBASTIAN, ORLA THORNTON, MARK DOBSON, RAMONA MCLOUGHLIN, MARTIN BUCKLEY, HUMPHREY O’CONNOR & COLM O’MORAIN Gastroenterology Department, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland Accepted for publication 5 August 2004 SUMMARY Background: Optimal management approach is not well defined for subjects who fail initial first- and second-line Helicobacter pylori eradication attempts and are dealt on a case-by-case basis by the specialists. Aim: To evaluate the efficacy and safety of standard and ‘rescue’ eradication therapies at primary and secondary care levels. Methods: H. pylori infected dyspepsia patients referred to our C13 urea breath testing laboratory between January 1999 to February 2002 were included. Eradication failure at secondary care level was treated using strategies including antibiotic sensitivity testing and the use of rifabutin- and furazolidone-based therapies. Results: 3280 patients received standard first-line eradication therapy, which was successful in 2530 (77%) patients. Second-line therapy (bismuth-based ‘quadruple’) or triple therapy (altering constituent antibiotics) was successful in 56% of 270 treated patients. Subsequent eradication attempts using rifabutin-based (n ¼ 34) and furazolidone-based (n ¼ 10) regimens were successful in 38% and 60% patients respectively. H. pylori eradication rates were significantly different for guidelines compliant (94.8%) and non-compliant (82%) groups (P ¼ 0.0001). H. pylori eradication rates for non- ulcer dyspepsia (40%) and peptic ulcer disease (36%) were not significantly different. Conclusions: Available H. pylori eradication therapies remain very effective and compliance to guidelines achieves high success rates. Furazolidone-based ‘rescue’ regimen achieved high eradication rates after failure of the standard first-line, second-line and rifabutin-based therapies. INTRODUCTION Non-invasive detection and eradication of Helicobacter pylori remains the mainstay of current management for the majority of patients with dyspepsia. 1–4 Available H. pylori eradication therapies are very effective. However, in a substantial number of patients primary and secondary eradication attempts are unsuccessful posing a significant therapeutic challenge. For these patients, current guidelines suggest a case-by-case approach at the specialist care level. 1 For patients who fail successive H. pylori eradication attempts various therapeutic modalities including antibiotic sensitivity testing, sequential regimens, rescue therapies and the use of novel antibiotic combinations have been tried. 5–9 A cost-effective approach, which can be recommended for repeated treatment failures at the primary care level remains to be decided. PATIENTS AND METHODS Our tertiary referral gastroenterology centre provides an ‘open access’ C13-UBT facility where local general Correspondence to: Prof. C. O’Morain, Department of Gastroenterology, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland. E-mail: gastroenterology@amnch.ie. Aliment Pharmacol Ther 2005; 21: 91–96. doi: 10.1111/j.1365-2036.2004.02210.x Ó 2005 Blackwell Publishing Ltd 91