Furazolidone-based quadruple therapy as first-line treatment for Helicobacter pylori infection

AIM: To observe the rates of symptom remission, adverse reactions, and Helicobacter pylori (H. pylori) eradication of furazolidone-based quadruple therapy as first-line treatment for patients with H. pylori infection.

METHODS: One hundred and fifty-two patients who were diagnosed with H. pylori-positive chronic gastritis or duodenal ulcer were randomly divided into three groups: control group (esomeprazole + bismuth potassium critrate + amoxicillin + clarithromycin), 7-day furazolidone-based quadruple therapy group (esomeprazole + bismuth potassium critrate + amoxicillin + furazolidone), and 10-day furazolidone-based quadruple therapy group (esomeprazole + bismuth potassium critrate + amoxicillin + furazolidone). Patients were followed to observe symptom remission and adverse reactions. After at least 4 wk of treatment and 2 wk of non-use of PPIs, H. pylori status was assessed using the urea breath test. H. pylori eradication rate was assessed by PP and ITT analysis. Cost-effectiveness ratio and incremental cost-effectiveness ratio were used to evaluate the three treatments.

RESULTS: On PP analysis, the rates of H. pylori eradication in the three groups were 87.50%, 88.89% and 93.62%. On ITT analysis, the rates of H. pylori eradication in the three groups were 79.25%, 83.33% and 86.27%. There were no significant differences in the rates of H. pylori eradication among the three groups either on PP analysis or on ITT analysis. The rates of symptom remission and adverse reactions in the three groups also showed no significant difference (all P > 0.05). The cost-effectiveness ratios of the three groups were 3.69, 2.48 and 3.37. The incremental cost-effectiveness ratios of the 7-day and 10-day furazolidone-based quadruple therapy groups relative to the control group were -73.22 and -1.17.

CONCLUSION: Furazolidone-based quadruple therapy is associated with a high rate of H. pylori eradication and few slight side effects and can reduce the costs of quadruple treatment.