Published online Oct 28, 2018. doi: 10.3748/wjg.v24.i40.4596
Peer-review started: July 2, 2018
First decision: July 25, 2018
Revised: August 16, 2018
Accepted: October 5, 2018
Article in press: October 5, 2018
Published online: October 28, 2018
Processing time: 117 Days and 22.2 Hours
With the increase of antibiotic resistance of Helicobacter pylori (H. pylori) worldwide, traditional triple therapies have become increasingly ineffective. Selecting optimal therapies for antibiotic-resistant H. pylori infection has become an important global public health priority.
Although studies with limited sample size demonstrate high efficacy of furazolidone-based quadruple therapy for treatment of H. pylori, data on the impact of adverse events and predictors of failed H. pylori eradication are not well described. Furthermore, evaluating efficacy and safety of furazolidone- and amoxicillin-based quadruple therapy for H. pylori and identifying predictors of failed eradication in a large patient population are lacking.
The aim of the study was to evaluate the outcomes of furazolidone- and amoxicillin-based quadruple therapy for treatment of H. pylori and identify predictors of failed eradication. Furazolidone- and amoxicillin-containing quadruple therapy demonstrated a high eradication rate exceeding 90% both as primary and rescue therapies with a favorable safety profile. Patient education targeting abstinence of alcohol use during therapy and strict medication adherence may further optimize H. pylori eradication. The results provided robust evidence for using furazolidone- and amoxicillin-containing quadruple therapy as a first-line therapy for H. pylori infection in areas with a high prevalence of clarithromycin resistance.
Patients with H. pylori infection who were treated with furazolidone- and amoxicillin-based quadruple therapy and received 13C-urea breath test > 4 wk after treatment from January 2015 to December 2015 were evaluated. Patient data including sociodemographic data, prior treatment attempts, medication adherence, and treatment-related adverse events were obtained by reviewing medical records and conducting telephone surveys. H. pylori eradication rates for overall and subgroups, treatment-related adverse events, and independent predictors of failed H. pylori eradication were evaluated.
Furazolidone- and amoxicillin-based quadruple therapy demonstrated a high eradication rate exceeding 90% as both primary and rescue therapies. Fewer than 3% of patients reported treatment-related adverse events leading to premature discontinuation. Poor medication adherence, previous H. pylori treatments, and alcohol consumption during therapy were associated with failed H. pylori eradication. These findings suggest that furazolidone- and amoxicillin-based quadruple therapy with proper patient education could optimize treatment of H. pylori infection in regions with high resistance to clarithromycin. Evaluating the efficacy of furazolidone- and amoxicillin-based quadruple therapy in areas other than China may be invaluable in future studies.
Furazolidone- and amoxicillin-based quadruple therapy demonstrated high eradication rates as both primary and rescue therapies for H. pylori infection with a favorable safety profile in areas with a high rate of clarithromycin resistance. Abstinence from alcohol and strict medication adherence during therapy may further optimize H. pylori eradication. These findings validate updated guidelines recommending furazolidone-containing quadruple therapy as a first-line regimen for treatment of H. pylori infection in populations with a high rate of clarithromycin resistance.
Selecting optimal treatment for H. pylori infection is important in regions with a high rate of resistance to clarithromycin. Targeted patient education may further optimize H. pylori eradication. Future studies confirming the high efficacy of furazolidone- and amoxicillin-based quadruple therapy in areas other than China may be invaluable.