Correspondence to Author: Dr. Arif A. Faruqui. 

MD, MBBS Clinical Pharmacologist Department of Pharmacology 504-A, Rizvi Mahal CHS Opp. K. B. Bhabha Hospital Bandra West, Mumbai-400050 Maharashtra, India

Abstract:

Helicobacter pylori (H. pylori) infection remains a global health challenge, with rising antibiotic resistance compromising the efficacy of standard eradication regimens. The rifaximin-metronidazole combination has emerged as a promising alternative, offering a dual mechanism of action, low resistance potential, and favorable safety profile. Rifaximin, a non-absorbable rifamycin derivative, exhibits high intraluminal concentrations and broad-spectrum activity against H. pylori, while metronidazole provides systemic coverage against deeper mucosal bacteria. In vitro studies have demonstrated rifaximins consistent activity against H. pylori, including clarithromycin- and metronidazole-resistant strains. Clinical trials evaluating rifaximin-based regimens have reported moderate eradication rates (55.3 - 85.4%), with the rifaximin-metronidazole combination showing 60% success as a dual therapy. While falling short of the ideal 90% eradication rate, this combination offers advantages in penicillinallergic patients, those intolerant to bismuth or macrolides, and in rescue therapy settings. The absence of large-scale randomized controlled trials and standardized protocols remains a limitation. Future research should focus on optimizing formulations, dosing, and treatment duration to enhance efficacy. Targeted studies in niche populations, such as those with prior treatment failures or gastrointestinal comorbidities, can further define the role of rifaximin-metronidazole in personalized treatment strategies. With its unique pharmacological benefits and potential for overcoming resistance barriers, the rifaximin-metronidazole combination warrants further investigation as a valuable addition to the H. pylori eradication arsenal.

Keywords: Helicobacter pylori, Rifaximin, Metronidazole, Antibiotic resistance, Eradication therapy.

Citation:

Dr. Arif A. Faruqui, Evaluating Rifaximin-Metronidazole Regimens for Helicobacter pylori Eradication: Current Evidence and Future Perspectives. Japanese Journal of Gastroenterology 2025.