Rescue Therapies for Helicobacter pylori Infection in Foreign Patients Treated in Italy

Background and Aims: Helicobacter pylori prevalence remains high worldwide, especially in developing areas where infection acquisition occurs in early childhood. H. pylori eradication fails in a definite number of patients, despite one or more therapeutic attempts. Curing these patients is progressively more difficult, due to development of antibiotic resistance. While the cure rate of first-line therapies in foreigners was found to be different from that of Italians, no data are available on rescue therapies. Materials and Methods: Consecutive foreigner patients with H. pylori infection following at least one therapy failure were enrolled. All patients underwent upper endoscopy with gastric biopsies used for both histologic examination and culture/susceptibility test. Rescue therapies administered accordingly to susceptibility testing were rifabutin-based therapy, levofloxacin-based therapy, sequential. Pylera was prescribed regardless the resistance pattern. Results: A total of 103 (M/F: 27/76, mean age: 41.9 y, range: 18 to 85) were enrolled. The overall resistance rates toward clarithromycin, metronidazole, and levofloxacin were 76.7%, 66%, and 42.7%, respectively, with triple resistance present in 33.9% of bacterial isolates. Eradication rates were 71.4% on 40 patients for rifabutin-based therapy, 82.8% on 42 cases for levofloxacin-based therapy, 75% on 11 patients treated with sequential therapy, and 100% on 10 cases who received Pylera regimen. Conclusions: To our knowledge, this is the first study assessing H. pylori eradication rates in foreigner patients, who failed at least one therapeutic attempt, managed in Italy. Even by using a culture-based approach, the infection was not cured in a definite number of patients.