Nitrofuran‐based regimens for the eradication of Helicobacter pylori infection

Abstract

Several aspects of Helicobacter pylori eradication have been meta-analyzed; however, nitrofuran-based therapies constitute an exception. The aim of this study was the systematic review and meta-analysis of the effect of furazolidone-and nitrofurantoin-based regimens in the eradication of infection. Studies evaluating the effects of nitrofurans on H. pylori were identified from Medline, EMBASE, the Cochrane Controlled Trials Register and congress abstracts. The studies were classified into groups based on first-, second-and third-line regimens. The pooled eradication rates and combined odd ratios of the individual studies were calculated and compared with the published meta-analysis. The factors influencing the efficiency of the regimens were also analyzed. Side-effects of nitrofuranbased regimens were also analyzed. The pooled eradication rate of primary proton pump inhibitor-based regimens containing furazolidone was 76.3% .2). The odds ratio for furazolidone-based regimens versus standard triple therapies was 2.34 (CI 0.76-3.92). Ranitidine bismuth citrate + furazolidone-based triple regimens were equally efficient (83.5%, CI 74.0-93.0, P = 0.06 versus triple therapies). Schedules including a H2 antagonist + furazolidone + one other antibiotic achieved pooled eradication rates of 79.9% (CI 67.8-89.9, P = 0.04). Bismuth-based triple therapies achieved 84.5% (CI 72.6-93.0, P = 0.002). Primary quadruple regimens containing furazolidone were superior to triple therapies (83.4%, CI 69.7-92.3, P = 0.01). Second-line schedules containing furazolidone obtained eradication rates of 76.1% (CI 66.4-85.0, P = 0.28 versus primary regimens). Third-line 'rescue' therapies were efficient in 65.5% of the cases (CI 56.3-75.5, P = 0.0001). Side-effects of the regimens containing furazolidone were more frequent than in standard therapies (P = 0.02). The combined odds ratio of side-effects for furazolidonebased versus standard therapies was 0.74 (CI 0.32-1.98). The duration of treatment, but not the furazolidone dose, influenced the treatment outcome. Primary triple regimens containing furazolidone are slightly less efficient than the standard primary combinations; primary quadruple regimens were more efficient than triple therapies. Furazolidone is also efficient as a component of second-line or rescue therapies.

3rd BRAZILIAN CONSENSUS ON Helicobacter pylori

“…The treatment is performed for 7 days, the doses of furazolidone used range from 100 mg (children) to 400 mg/day, with frequent adverse effects, particularly gastrointestinal (28,35,63,107,128) . A systematic review and meta-analysis of the effects of furazolidone and nitrofurantoinic derivatives in eradicating H pylori showed that schemes using such drugs had more frequent adverse effects and slightly less effective eradication rates when compared with the classic triple therapy (12) .…”

Clinical Management of <b><i>Helicobacter pylori</i></b>: The Latin American Perspective

“…A systematic review and meta-analysis of the effect of furazolidone- and nitrofurantoin-based regimens in the eradication of infection showed that the side effects of the regimens containing furazolidone were significantly more frequent than in standard therapies. Primary triple regimens containing furazolidone are slightly less efficient than the standard primary combinations [63]. …”

Furazolidone, Co-amoxiclav, Colloidal Bismuth Subcitrate, and Esomeprazole for Patients Who Failed to Eradicate Helicobacter pylori with Triple Therapy

“…Furazolidone has been shown to be an efficient component of first-and second-line and rescue therapies. Buzas and Jozan [25] have reviewed the efficacy of furazolidone-based therapies. Primary quadruple regimens containing furazolidone were superior to triple therapies with 83.5% eradication rate.…”

“…The third drug used in our combination was a bismuth compound, which does not have any resistance problem. Treatment was given for 14 days based on the results of the review suggesting the 'longer the better' [2,25]. PPI was also given twice a day to increase the local pH in the microenvironment surrounding H. pylori to prevent phenotypic resistance [26].…”