Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2018; 24(40): 4596-4605
Published online Oct 28, 2018. doi: 10.3748/wjg.v24.i40.4596
Outcomes of furazolidone- and amoxicillin-based quadruple therapy for Helicobacter pylori infection and predictors of failed eradication
Ya-Wen Zhang, Wei-Ling Hu, Yuan Cai, Wen-Fang Zheng, Qin Du, John J Kim, John Y Kao, Ning Dai, Jian-Min Si
Ya-Wen Zhang, Wei-Ling Hu, Yuan Cai, Wen-Fang Zheng, Ning Dai, Jian-Min Si, Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Ya-Wen Zhang, Wei-Ling Hu, Wen-Fang Zheng, Jian-Min Si, Institute of Gastroenterology, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Qin Du, Department of Gastroenterology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
John J Kim, Division of Gastroenterology, Loma Linda University, Loma Linda, CA 92354, United States
John Y Kao, Division of Gastroenterology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, United States
Author contributions: Hu WL, Dai N and Si JM designed the study; Zhang YW, Cai Y and Zheng WF performed the research; Du Q contributed to providing support to patients; Zhang YW and Kim JJ analyzed the data; Zhang YW wrote the paper; Hu WL, Kim JJ and Kao JY critically revised the manuscript; all authors had access to the study data and had reviewed and approved the final version of the article.
Supported by the Zhejiang Science and Technology Project, No. LGF18H160012.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Sir Run Run Shaw Hospital.
Informed consent statement: Patients were not required to provide informed consent to the study because the data were obtained retrospectively after completing treatment.
Conflict-of-interest statement: The authors received grants from Zhejiang Science and Technology Project during the conduct of the study and declare no other conflict of interest related to this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Wei-Ling Hu, MD, PhD, Doctor, Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, East Qingchun Road, Hangzhou 310016, Zhejiang Province, China. huweiling@zju.edu.cn
Telephone: +86-571-86006181 Fax: +86-571-86006181
Received: July 1, 2018
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
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.