Furazolidone treatment for <i>Helicobacter Pylori</i> infection: A systematic review and meta‐analysis

Zhuge, Liya; Wang, Youhua; Wu, Shuang; Zhao, Rulin; Li, Zhen; Xie, Yong

doi:10.1111/hel.12468

Cited by 57 publications

(59 citation statements)

References 36 publications

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“…When given a high daily dose of furazolidone ranging from 300 mg to 400mg, patients had an obvious higher risk of total AEs and severe AEs compared with the low-dose regimen. Meanwhile, the incidence of nausea and dizziness also became more frequent, which was similar with results reported by Zhuge et al 33 These findings suggested that prescription of furazolidone should be started with a minimum necessary dose of 100 mg twice daily to avoid potential severe AEs. If a low-dose regimen fails to achieve expected therapeutic efficacy, extending the duration of furazolidone should be first considered rather than increasing the daily dose.…”

Section: Open Accesssupporting

confidence: 88%

Safety of furazolidone-containing regimen in Helicobacter pylori infection: a systematic review and meta-analysis

Liu

et al. 2020

BMJ Open

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ObjectivesFurazolidone containing regimen is effectivefor Helicobacter pylori (H. pylori) infection, but its safetyremains controversial. To assess the safety of furazolidone containing regimenin H. pylori infection.DesignA systematic review and meta-analysis.Data sourcesPubMed, Embase, Cochrane Library, Web of Science and Scopus databases were systematically searched for eligible randomised controlled trials.Eligibility criteriaStudies comparing furazolidone with non-furazolidone-containing regimen, variable durations or doses of furazolidone were included.Data extraction and synthesisTwo reviewers independently selected studies and extracted data. Primary outcomes were the risk of total adverse events (AEs), serious AEs and severe AEs, expressed as relative risk (RR) with 95% CI. Secondary outcomes contained the incidence of individual adverse symptoms, AE-related treatment discontinuation and compliance.ResultsTwenty-six articles were identified from 2039 searched records, of which 14 studies (n=2540) compared furazolidone with other antibiotics. The eradication rates of furazolidone-containing regimen were higher than those of other antibiotics in both intention-to-treat (RR 1.06, 95% CI 1.01 to 1.12) and per-protocol analysis (RR 1.05, 95% CI 1.00 to 1.10). Only two serious AEs were reported in furazolidone group (2/1221, 0.16%). No significant increased risk was observed for the incidence of total AEs (RR 1.04, 95% CI 0.89 to 1.21) and severe AEs (RR 1.81, 95% CI 0.91 to 3.60). Twelve studies (n=3139) compared different durations of furazolidone, and four studies (n=343) assessed variable doses. Elevated risk of total AEs and severe AEs were only found in a high daily dose of furazolidone rather than prolonged duration. The incidence of AE-related treatment discontinuation and compliance of patients were all similar, irrespective of dose and duration adjustments.ConclusionFurazolidone-containing regimen has a similar risk of AEs and compliance as non-furazolidone-containing regimen. A low daily dose of 200 mg is well-tolerated for 14 day regimen and should be first considered.PROSPERO registration numberCRD42019137247

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Section: Open Accesssupporting

confidence: 88%

Safety of furazolidone-containing regimen in Helicobacter pylori infection: a systematic review and meta-analysis

Liu

et al. 2020

BMJ Open

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“…The antimicrobial susceptibility of E. coli K-12 strains to 5-nitrofurans was examined using the agar dilution and broth microdilution assays as previously described (65,66). The range of drug concentrations tested included 32,28,24,20,16,12,8,4, 2, 1, 0.5, 0.25, 0.125, and 0 g/ml in the agar dilution assay and 80, 64, 48, 32, 16, 8, 4, 2, 1, 0.5, and 0.25 g/ml in the broth microdilution assay. In ahpF-complemented strains, expression of ahpF was under the control of a chimeric P T5-lac promoter of a high-copy-number plasmid, pCA24N::ahpF, and induced by 0.1 mM or 1 mM IPTG.…”

Section: Methodsmentioning

confidence: 99%

Novel 5-Nitrofuran-Activating Reductase in Escherichia coli

Davies

Moon

et al. 2019

Antimicrob Agents Chemother

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The global spread of multidrug-resistant enterobacteria warrants new strategies to combat these pathogens. One possible approach is the reconsideration of “old” antimicrobials, which remain effective after decades of use. Synthetic 5-nitrofurans such as furazolidone, nitrofurantoin, and nitrofurazone are such a class of antimicrobial drugs. Recent epidemiological data showed a very low prevalence of resistance to this antimicrobial class among clinical Escherichia coli isolates in various parts of the world, forecasting the increasing importance of its uses to battle antibiotic-resistant enterobacteria. However, although they have had a long history of clinical use, a detailed understanding of the 5-nitrofurans’ mechanisms of action remains limited. Nitrofurans are known as prodrugs that are activated in E. coli by reduction catalyzed by two redundant nitroreductases, NfsA and NfsB. Furazolidone, nevertheless, retains relatively significant antibacterial activity in the nitroreductase-deficient ΔnfsA ΔnfsB E. coli strain, indicating the presence of additional activating enzymes and/or antibacterial activity of the unreduced form. Using genome sequencing, genetic, biochemical, and bioinformatic approaches, we discovered a novel 5-nitrofuran-activating enzyme, AhpF, in E. coli. The discovery of a new nitrofuran-reducing enzyme opens new avenues for overcoming 5-nitrofuran resistance, such as designing nitrofuran analogues with higher affinity for AhpF or screening for adjuvants that enhance AhpF expression.

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“…7 Compared to high rates of resistance observed with traditional antibiotics, H pylori strains resistant to furazolidone remain uncommon. 8 There have been many studies on the effectiveness and safety of furazolidone in the eradication of H pylori infection from the United States, China, Iran, etc 9 Our previous multicenter randomized controlled trial in a province-wide study revealed that the eradication rates of the furazolidone-containing regimen were 86.1% and 92.3% in patients with H pylori infections according to intention-to-treat (ITT) and per-protocol (PP) analyses, respectively. 10 We also conducted a multicenter randomized controlled trial with 16 hospitals across 13 provinces in China, and the results showed that furazolidone-containing therapies exhibited satisfactory effectiveness and safety in patients with H pylori infections.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of furazolidone‐containing quadruple regimens in patients with Helicobacter pylori infection in real‐world practice

et al. 2019

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Background & Aims The eradication rate of Helicobacter pylori (H pylori) has decreased largely because of the antibiotic resistance. We aimed to evaluate the effectiveness and safety of furazolidone‐containing quadruple regimens for H pylori eradication. Methods This was an observational study of furazolidone‐containing quadruple regimens for H pylori infection in real‐world settings. Data sets were collected from the medical records and telephone interviews of patients referred to a specialist clinic for suspected H pylori reinfection from January 1, 2015, to January 1, 2018, at the First Affiliated Hospital of Nanchang University. Main outcome measures were the eradication rate and adverse reactions during medication. Results Among 584 patients with H pylori infection that met the inclusion criteria, 561 (96.1%) were treated for the first time, 19 (3.3%) had one, and 4 (0.5%) had two or more prior to furazolidone‐containing quadruple regimens. The eradication rates for 10‐day and 14‐day regimens were 93.7% (95% CI: 91.5%‐95.9%) vs 98.2% (95% CI: 95.6%‐99.3%), respectively (P = 0.098). Adverse drug reactions occurred in 8.2% (48/584) with abdominal discomfort being the most common symptom. Overall adverse events with 10‐day regimens were lower than 14‐day regimens (6.1% vs 17.4%, P < 0.001). Logistic regression analysis indicated that poor adherence (adjusted odds ratio [AOR] = 46.5, 95% CI: 9.7‐222.4) was correlated with failed eradication. Adverse drug reactions during medication were related to smoking and tobacco status, alcohol intake history, regimens combined with tetracycline, and poor adherence (all P < 0.05). Conclusions Furazolidone‐containing quadruple regimens proved both safe and highly effective in a real‐world setting.

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Furazolidone treatment for Helicobacter Pylori infection: A systematic review and meta‐analysis

Cited by 57 publications

References 36 publications

Safety of furazolidone-containing regimen in Helicobacter pylori infection: a systematic review and meta-analysis

Safety of furazolidone-containing regimen in Helicobacter pylori infection: a systematic review and meta-analysis

Novel 5-Nitrofuran-Activating Reductase in Escherichia coli

Effectiveness and safety of furazolidone‐containing quadruple regimens in patients with Helicobacter pylori infection in real‐world practice

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