Furazolidone therapy for Helicobacter pylori: Is it effective and safe?

Francesco, De; Ierardi, Enzo; Hassan, Cesare; Zullo, Angelo

doi:10.3748/wjg.15.1914

Cited by 20 publications

(8 citation statements)

References 6 publications

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“…Furazolidone is a synthetic nitrofuran that has been widely used as an antibiotic to treat enteric infections globally. The carcinogenetic effects of furazolidone suggested in early animal studies[ 12 - 15 , 40 ] have remained speculative in clinical settings. Furazolidone is a category 3 agent and considered unclassifiable in regards to carcinogenicity in humans[ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of furazolidone- and amoxicillin-based quadruple therapy forHelicobacter pyloriinfection and predictors of failed eradication

Zhang¹,

Hu²,

Cai³

et al. 2018

WJG

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AIMTo evaluate the outcomes of furazolidone- and amoxicillin-based quadruple therapy for treatment of Helicobacter pylori (H. pylori) infection and identify predictors of failed eradication.METHODSPatients with H. pylori infection treated with furazolidone, amoxicillin, bismuth, and proton pump inhibitor therapy (January 2015 to December 2015) who received the 13C-urea breath test > 4 wk after treatment were evaluated. Demographic and clinical data including prior H. pylori treatment attempts, medication adherence, alcohol and cigarette consumption during therapy, and treatment-related adverse events were recorded by reviewing medical records and telephone surveys. H. pylori eradication rates for overall and subgroups were evaluated. Multivariate analysis was performed to identify independent predictors of failed H. pylori eradication.RESULTSOf the 992 patients treated and retested for H. pylori infection, the overall eradication rate was 94.5% [95% confidence interval (CI): 94.1%-95.9%]. H. pylori eradication rate of primary therapy was 95.0% (95%CI: 93.5%-96.5%), while that of rescue therapy was 91.3% (95%CI: 86.8%-95.8%). Among the 859 patients who completed the study protocol, 144 (17%) reported treatment-related adverse events including 24 (3%) leading to premature discontinuation. On multivariate analysis, poor medication adherence [adjusted odds ratio (AOR) = 6.7, 95%CI: 2.8-15.8], two or more previous H. pylori treatments (AOR = 7.4, 95%CI: 2.2-24.9), alcohol consumption during therapy (AOR = 4.4, 95%CI: 1.5-12.3), and possibly smoking during therapy (AOR = 1.9, 95%CI: 0.9-4.3) were associated with failed H. pylori eradication.CONCLUSIONFurazolidone- and amoxicillin-based quadruple therapy for H. pylori infection in an area with a high prevalence of clarithromycin resistance demonstrated high eradication rates as primary and rescue therapies with a favorable safety profile. Patient education targeting abstinence from alcohol during therapy and strict medication adherence may further optimize H. pylori eradication.

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Section: Discussionmentioning

confidence: 99%

Outcomes of furazolidone- and amoxicillin-based quadruple therapy forHelicobacter pyloriinfection and predictors of failed eradication

Zhang¹,

Hu²,

Cai³

et al. 2018

WJG

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“…The very limited experience in children with a quadruple therapy containing furazolidone has yielded relatively good results (49). However, the inclusion of furazolidone in a treatment regimen for H. pylori infection is, at least, controversial, and it does not appear to be safe (50). Different studies have raised several concerns about this agent and its potential for possible genotoxic and carcinogenetic effects (50).…”

Section: Re-treatmentmentioning

confidence: 99%

“…However, the inclusion of furazolidone in a treatment regimen for H. pylori infection is, at least, controversial, and it does not appear to be safe (50). Different studies have raised several concerns about this agent and its potential for possible genotoxic and carcinogenetic effects (50). The FDA withdrew its approval for furazolidone in March 2005.…”

Section: Re-treatmentmentioning

confidence: 99%

Helicobacter Pylori Therapy in Children: Overview and Challenges

Chiesa

Pacifico

Anania

et al. 2010

Int J Immunopathol Pharmacol

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Helicobacter pylori is one of the most common infections found in humans. It was first identified in 1982 and by 1989 had been associated with gastric inflammation and ulcers in adults and children. During the 1990's evidence emerged of its etiologic role in stomach cancers in adults. That the infection is common and may have serious consequences, has led to an avalanche of research during the last twenty years. During this time, there have been many studies on children which have sought an effective and safe treatment to eradicate the infection, but as yet, no therapy regimen has been found which is always effective and safe. This article provides information, from a pediatric point of view, on the major developments in the therapeutics and therapy of H. pylori infection. It examines first-line treatment regimens, evaluates the efficacy of the main drugs used in the management of (primary) H. pylori infection in children, assesses the potential for the use of probiotics and sequential therapy, examines therapeutic options after failure of initial treatment, and discusses factors affecting eradication rate, including antibiotic resistance, adherence to therapy, and bacterial factors.

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“…The options are to use further empiric regimes or to employ treatments tailored to individual antibiotic sensitivities. Two of the more common empiric rescue antibiotics used are rifabutin [32] and furizoladone [33]. Rifabutin is an antituberculous agent.…”

Section: Third‐line Therapymentioning

confidence: 99%

Treatment of Helicobacter pylori Infection

2009

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This article aims to examine current best practice in the field reference to first‐line, second‐line, rescue and emerging treatment regimens for Helicobater pylori eradication. The recommended first‐line treatment in published guidelines in Europe and North American is proton pump inhibitor combined with amoxicillin and clarithromycin being the favoured regimen. Rates of eradication with this regimen however are falling alarmingly due to a combination of antibiotic resistance and poor compliance with therapy. Bismuth based quadruple therapies and levofloxacin based regimes have been shown to be effective second line regimens. Third‐line options include regimes based on rifabutin or furazolidone, but susceptibility testing is the most rational option here, but is currently not used widely enough. Sequential therapy is promising but needs further study and validation outside of Italy. Although the success of first line treatments is falling, if compliance is good and a clear treatment paradigm adhered to, almost universal eradication rates can still be achieved. If compliance is not achievable, the problem of antibiotic resistance will continue to beset any combination of drugs used for H. pylori eradication.

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Furazolidone therapy for Helicobacter pylori: Is it effective and safe?

Cited by 20 publications

References 6 publications

Outcomes of furazolidone- and amoxicillin-based quadruple therapy forHelicobacter pyloriinfection and predictors of failed eradication

Outcomes of furazolidone- and amoxicillin-based quadruple therapy forHelicobacter pyloriinfection and predictors of failed eradication

Helicobacter Pylori Therapy in Children: Overview and Challenges

Treatment of Helicobacter pylori Infection

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