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Author Spotlight: Detection and Treatment of Helicobacter pylori Infection
Published on: July 28, 2023
Effectiveness and Safety of Rifaximin-Containing Regimens for Helicobacter pylori Eradication: Systematic Review -
Yu Wang1, Jiong Tang2, Su Zhou3
1Department of Pharmacy, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, People's Republic of China.
Background:
Rifaximin, a rifamycin antibiotic, is widely used to treat infectious diarrhea but not commonly used in H. pylori eradication. With its potential advantages of the agent, some studies were conducted on this topic. The aim of this study is to assess effectiveness and safety of rifaximin-containing regimens and to evaluate whether they are alternative choices for H. pylori eradication.
Methods:
Scientific databases including PubMed, EMbase and Cochrane Library were used to identify clinical trials on rifaximin-containing regimens published from January 2000 to October 2021. Review Manager 5.4 and STATA12 were adopted for the systematic review.
Results:
In this study, totally 1025 patients were included from 3 randomized controlled and 9 single-arm studies. It showed that the differences in effectiveness and safety between rifaximin-containing and first-line regimens were not statistically significant in randomized controlled trials. However, the results of the single-arm trials indicated that the eradication and adverse drug reaction rate varied suggesting data instability (r=38.1%-85.4%, r ADR 0.00-67.5% by ITT analysis). Among them, the eradication rate of pediatric patients (r=85.4% by ITT analysis) was higher than that of adult patients (r=38.1-74.5% by ITT analysis). Meanwhile, in all adult subgroups (triple or quadruple, with or without amoxicillin, different duration and rifaximin dose), the results did not show sufficient effectiveness as all the eradication rates did not meet the minimum ideal or ideal target.
Conclusion:
Taken together, rifaximin-containing regimens should not be recommended for H. pylori eradication as they cannot achieve the eradication rate desired.
Insights
Rifaximin is not recommended for H. pylori eradication. Studies show rifaximin-containing regimens do not achieve desired eradication rates, especially in adults, making them unsuitable alternatives.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Pharmacology
Background:
- Rifaximin, an antibiotic, is used for infectious diarrhea but not widely for H. pylori eradication.
- Investigating rifaximin's potential advantages for H. pylori eradication is of interest.
Purpose of the Study:
- To assess the effectiveness and safety of rifaximin-containing regimens for H. pylori eradication.
- To evaluate if these regimens are viable alternatives to standard treatments.
Main Methods:
- A systematic review of clinical trials published between January 2000 and October 2021 from PubMed, EMbase, and Cochrane Library.
- Analysis included 1025 patients from 3 randomized controlled and 9 single-arm studies, using Review Manager 5.4 and STATA12.
Main Results:
- Randomized controlled trials showed no significant difference in effectiveness or safety compared to first-line regimens.
- Single-arm trials revealed unstable eradication rates (38.1%-85.4%) and adverse drug reaction rates (0.00-67.5%).
- Pediatric eradication rates (85.4%) were higher than adult rates (38.1%-74.5%), with adult subgroups failing to meet ideal eradication targets.
Conclusions:
- Rifaximin-containing regimens are not recommended for H. pylori eradication.
- Current evidence indicates these regimens do not achieve the desired eradication rates.
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