Rifabutin-Containing Therapy for <i>Helicobacter pylori</i> Eradication: A Review

Helicobacter pylori infection is a leading cause of chronic gastritis, peptic ulcer disease, mucosa-associated lymphoid tissue lymphoma, and gastric cancer. Consequently, H. pylori eradication is recommended as a primary prevention strategy for gastric cancer, even in asymptomatic individuals. However, the global rise in antibiotic resistance has led to increasing eradication failures, even with first-line bismuth quadruple therapies. Rifabutin, a rifamycin derivative, has shown promise as an alternative treatment option, both as a rescue therapy and even as first-line therapy, due to its potent bactericidal activity, high gastric concentration, and stability across a broad pH range. This review summarizes the efficacy and safety of rifabutin-containing H. pylori eradication regimens, as reported in various studies. We analyze the impact of rifabutin dosage, combinations with other antibiotics and gastric acid inhibitors, bismuth inclusion, therapy duration, and demographic factors on treatment efficacy and patient compliance. Furthermore, we review rifabutin resistance in H. pylori, including the underlying mechanisms. Future large-scale, multicenter clinical trials are needed to optimize rifabutin-containing H. pylori eradication regimens. These trials should focus on rifabutin dosing strategies, the incorporation of potassium-competitive acid blockers, evaluation of potential benefits from bismuth addition, and exploration of shorter, 7-day treatment durations. Establishing standardized susceptibility testing methods and clinical minimum inhibitory concentration breakpoints for rifabutin resistance is also important for a better understanding of its role in H. pylori treatment and for optimizing its use in both rescue and first-line therapies.