Clarithromycin versus furazolidone for naïve Helicobacter pylori infected patients in a high clarithromycin resistance area

Abstract

Background and Aim The increase in antibiotic resistance makes the eradication of Helicobacter pylori more difficult. Considering the limitations of the application of susceptibility‐guided therapy, it is important to find an effective empirical regimen. The aim of the study is to compare the efficacy, safety, and cost‐effectiveness of clarithromycin‐based bismuth‐containing quadruple therapy (C‐BQT) and furazolidone‐based bismuth‐containing quadruple therapy (F‐BQT) in naïve H. pylori positive patients. Methods This was an open‐label, randomized controlled, crossover trial. The trial comprised two phases. In C‐F group, patients received C‐BQT in the first phase; those who were still positive for H. pylori infection after the first phase entered the second phase to receive F‐BQT as rescue treatment. In F‐C group, patients were treated with F‐BQT firstly and rescued with C‐BQT. Results As first‐line treatments, the eradication rates of C‐BQT and F‐BQT were 89.7% (157/175) and 92.0% (161/175) (P = 0.458) in intention‐to‐treat analysis and 93.4% (156/167) and 95.8% (161/168) (P = 0.327) in per‐protocol analysis, respectively. The cumulative eradication rates of the C‐F group and the F‐C group were both 94.3% in intention‐to‐treat analysis (P = 1.000). Cost‐effectiveness indexes of F‐BQT and C‐BQT were 0.54 and 1.24 in first‐line treatments. Frequencies of adverse events in F‐BQT and C‐BQT had no differences (36.0% in C‐BQT vs 32.6% in F‐BQT, P = 0.499). Conclusions Furazolidone‐based bismuth‐containing quadruple therapy should be preferred for its excellent cost‐effectiveness and acceptable safety.

Antibiotic resistance status of helicobacter pylori strains isolated from initial eradication patients in Ningbo, China, from 2017 to 2021

“…Amoxicillin, clarithromycin, levofloxacin, and furazolidone are frequently used antibiotics in the first-line treatment of H. pylori in China. 10,11 The trend of rising rates of resistance to antibiotics in H. pylori strains and its multiple resistance patterns increases the difficulty of eradication treatment in the clinic. 15 Therefore, despite bismuth-containing quadruple therapy being adopted, initial clinical empirical medical practice in these regions.…”

“…9 In China, amoxicillin, levofloxacin, furazolidone, and clarithromycin are the most frequently used antibiotics constituting these regimens. 10,11 The process of antibiotic resistance of H. pylori is evolving and dynamic. The status of antibiotic sensitivity and type of resistance seriously affects the success rate of initial eradication therapy in clinical patients.…”

Current guidelines for Helicobacter pylori treatment in East Asia 2022: Differences among China, Japan, and South Korea

“…FZD is a nitrofuran antibiotic effective against gram-negative and -positive bacteria[ 27 ]. Qiao et al [ 28 ] reported that an FZD-based BQT showed a similar first-line H. pylori eradication rate in PP analysis to a CAM-based BQT (95.8% vs 93.4%). The resistance rates of H. pylori to AMX, TET, and FZD remain low in China at < 5%[ 29 ].…”

Effects of enhanced education for patients with the Helicobacter pylori infection: A systematic review and meta‐analysis

“…Although there are many highly effective treatment regimens, 6,7 only around 70% of initial cases are successfully eradicated. 8 Many factors contribute to this limited rate, especially including poor compliance.…”

“…pylori eradication rate is unsatisfactory. Although there are many highly effective treatment regimens, 6,7 only around 70% of initial cases are successfully eradicated 8 9–12 .…”