The Furazolidone-based First-line Therapy for Helicobacter Pylori Infection: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

HUANG Xuan ,  LV bin , MENG Lina

Department of Gastroenterology, The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou 310006, China;

Corresponding author：

LV bin, Email: huangxuan1976@163.com

Keywords：

Furazolidone; Helicobacter pylori; Meta-analysis

DOI：

10.7507/1672-2531.20100543

Video：

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Objective 　To evaluate the efficacy and safety of furazolidone-based first-line therapy for Helicobacter pylori infection.
Methods 　The randomized controlled trials (RCTs) of furazolidone-based first-line therapy for Helicobacter pylori infection were identified from Cochrane Library (Issue 1, 2009), PubMed (1992 to January 2009), OVID (1994 to January 2009), Wanfang Data (1994 to January 2009), CNKI (1994 to January 2009), and VIP Data (1994 to January 2009). The quality of included RCTs was assessed, and the meta-analysis was conducted with RevMan5.0 software.
Results 　Among five included RCTs involving 499 patients, four were graded as B in methodology quality and the left one was graded as C. As to the intention-to-treat (ITT) analysis, the Helicobacter pylori eradication rate was 78.3% in furazolidone group and 66.8% in control group (RR=1.18, 95%CI 0.86 to 1.62), while the Per Protocol (PP) analysis, the eradication rate of furazolidone group and control group was 83.1% and 70.9% respectively (RR=1.17, 95%CI 0.88 to 1.57). The incidence rate of mild side-effects was 40.8% in furazolidone group and 39.4% in control group (RR=1.03, 95%CI 0.79 to 1.36), and while that of severe side-effects in furazolidone group and control group was 7.8% and 3.7% respectively (RR=1.86, 95%CI 0.84 to 4.09).
Conclusions 　With similar efficacy and safety as control group has, the furazolidone-based therapy could be recommended as a first-line therapy for Helicobacter pylori infection. The high-quality RCTs with large sample are required to prove the above conclusion for the limitation of quantity and quality of included studies.

Citation： HUANG Xuan,LV bin,MENG Lina. The Furazolidone-based First-line Therapy for Helicobacter Pylori Infection: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2010, 10(9): 1048-1052. doi: 10.7507/1672-2531.20100543 Copy

1.	孟灵梅, 周丽雅, 林三仁, 等. 幽门螺杆菌与消化性溃疡关系的10年随访研究. 中华消化杂志, 2009, 29(6): 361-364.
2.	周丽雅, 林三仁, 丁士刚, 等. 根除幽门螺杆菌对胃癌患病率及胃黏膜组织学变化的八年随访研究. 中华消化杂志, 2005, 25(6): 324-327.
3.	中华医学会消化病学分会幽门螺杆菌学组. 中国幽门螺杆菌耐药状况以及耐药对治疗的影响. 胃肠病学, 2007, 12(9): 525-530.
4.	Khatibian M, Ajvadi Y, Nasseri-Moghaddam S, et al. Furazolidone-based, metronidazole-based, or a combination regimen for eradication of Helicobacter pylori in peptic ulcer disease. Arch Iran Med, 2007, 10(2): 161-167.
5.	Cheng H, Hu FL. Furazolidone, amoxicillin, bismuth and rabeprazole quadruple rescue therapy for the eradication of Helicobacter pylori. World J Gastroenterol, 2009, 15(7): 860-864.
6.	Malfertheiner P, Megraud F, O’Morain C, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut, 2007, 56(6): 772-781.
7.	Alderson P, Green S, Higgins JPT. Cochrane Reviewers’Handbook 4.2.2[updated March 2004]. In: The Cochrane Library, Issue 1, 2004.
8.	Liu WZ, Xiao SD, Shi Y, et al. Furazolidone-containing short-term triple therapies are effective in the treatment of Helicobacter pylori infection. Aliment Pharmacol Ther, 1999, 13(3): 317-322.
9.	Fakheri H, Malekzadeh R, Merat S, et al. Clarithromycin vs. furazolidone in quadruple therapy regimens for the treatment of Helicobacter pylori in a population with a high metronidazole resistance rate. Aliment Pharmacol Ther, 2001, 15(3): 411-416.
10.	Ecclissato C, Marchioretto MA, Mendonca S, et al. Increased primary resistance to recommended antibiotics negatively affects Helicobacter pylori eradication. Helicobacter, 2002, 7(1): 53-59.
11.	杨伏. 奥美拉唑、阿莫西林、呋喃唑酮三联根除幽门螺杆菌感染的疗效观察. 现代医药卫生, 2004, 20(15): 1469-1470.
12.	Frota LC, da CMP, Luz CR, et al. Helicobacter pylori eradication using tetracycline and furazolidone versus amoxicillin and azithromycin in lansoprazole based triple therapy: an open randomized clinical trial. Arq Gastroenterol, 2005, 42(2): 111-115.
13.	European Helicobacter Pylori Study Group.Current European concepts in the management of Helicobacter pylori infection. The Maastricht Consensus Report. Gut, 1997, 41(1): 8-13.
14.	Paoluzi P, Iacopini F, Crispino P, et al. 2-week triple therapy for Helicobacter pylori infection is better than 1-week in clinical practice: a large prospective single-center randomized study. Helicobacter, 2006, 11(6): 562-568.
15.	Calvet X, Ducons J, Bujanda L, et al. Seven versus ten days of rabeprazole triple therapy for Helicobacter pylori eradication: a multicenter randomized trial. Am J Gastroenterol, 2005, 100(8): 1696-1701.
16.	Rokkas T, Sechopoulos P, Robotis I, et al. Cumulative H. pylori eradication rates in clinical practice by adopting first and second-line regimens proposed by the Maastricht III consensus and a third-line empirical regimen. Am J Gastroenterol, 2009, 104(1): 21-25.
17.	Kwon DH, Lee M, Kim JJ, et al. Furazolidone- and nitrofurantoin-resistant Helicobacter pylori: prevalence and role of genes involved in metronidazole resistance. Antimicrob Agents Chemother, 2001, 45(1): 306-308.
18.	Treiber G, Wittig J, Ammon S, et al. Clinical outcome and influencing factors of a new short-term quadruple therapy for Helicobacter pylori eradication: a randomized controlled trial (MACLOR study). Arch Intern Med, 2002, 162(2): 153-160.

1. 孟灵梅, 周丽雅, 林三仁, 等. 幽门螺杆菌与消化性溃疡关系的10年随访研究. 中华消化杂志, 2009, 29(6): 361-364.
2. 周丽雅, 林三仁, 丁士刚, 等. 根除幽门螺杆菌对胃癌患病率及胃黏膜组织学变化的八年随访研究. 中华消化杂志, 2005, 25(6): 324-327.
3. 中华医学会消化病学分会幽门螺杆菌学组. 中国幽门螺杆菌耐药状况以及耐药对治疗的影响. 胃肠病学, 2007, 12(9): 525-530.
4. Khatibian M, Ajvadi Y, Nasseri-Moghaddam S, et al. Furazolidone-based, metronidazole-based, or a combination regimen for eradication of Helicobacter pylori in peptic ulcer disease. Arch Iran Med, 2007, 10(2): 161-167.
5. Cheng H, Hu FL. Furazolidone, amoxicillin, bismuth and rabeprazole quadruple rescue therapy for the eradication of Helicobacter pylori. World J Gastroenterol, 2009, 15(7): 860-864.
6. Malfertheiner P, Megraud F, O’Morain C, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut, 2007, 56(6): 772-781.
7. Alderson P, Green S, Higgins JPT. Cochrane Reviewers’Handbook 4.2.2[updated March 2004]. In: The Cochrane Library, Issue 1, 2004.
8. Liu WZ, Xiao SD, Shi Y, et al. Furazolidone-containing short-term triple therapies are effective in the treatment of Helicobacter pylori infection. Aliment Pharmacol Ther, 1999, 13(3): 317-322.
9. Fakheri H, Malekzadeh R, Merat S, et al. Clarithromycin vs. furazolidone in quadruple therapy regimens for the treatment of Helicobacter pylori in a population with a high metronidazole resistance rate. Aliment Pharmacol Ther, 2001, 15(3): 411-416.
10. Ecclissato C, Marchioretto MA, Mendonca S, et al. Increased primary resistance to recommended antibiotics negatively affects Helicobacter pylori eradication. Helicobacter, 2002, 7(1): 53-59.
11. 杨伏. 奥美拉唑、阿莫西林、呋喃唑酮三联根除幽门螺杆菌感染的疗效观察. 现代医药卫生, 2004, 20(15): 1469-1470.
12. Frota LC, da CMP, Luz CR, et al. Helicobacter pylori eradication using tetracycline and furazolidone versus amoxicillin and azithromycin in lansoprazole based triple therapy: an open randomized clinical trial. Arq Gastroenterol, 2005, 42(2): 111-115.
13. European Helicobacter Pylori Study Group.Current European concepts in the management of Helicobacter pylori infection. The Maastricht Consensus Report. Gut, 1997, 41(1): 8-13.
14. Paoluzi P, Iacopini F, Crispino P, et al. 2-week triple therapy for Helicobacter pylori infection is better than 1-week in clinical practice: a large prospective single-center randomized study. Helicobacter, 2006, 11(6): 562-568.
15. Calvet X, Ducons J, Bujanda L, et al. Seven versus ten days of rabeprazole triple therapy for Helicobacter pylori eradication: a multicenter randomized trial. Am J Gastroenterol, 2005, 100(8): 1696-1701.
16. Rokkas T, Sechopoulos P, Robotis I, et al. Cumulative H. pylori eradication rates in clinical practice by adopting first and second-line regimens proposed by the Maastricht III consensus and a third-line empirical regimen. Am J Gastroenterol, 2009, 104(1): 21-25.
17. Kwon DH, Lee M, Kim JJ, et al. Furazolidone- and nitrofurantoin-resistant Helicobacter pylori: prevalence and role of genes involved in metronidazole resistance. Antimicrob Agents Chemother, 2001, 45(1): 306-308.
18. Treiber G, Wittig J, Ammon S, et al. Clinical outcome and influencing factors of a new short-term quadruple therapy for Helicobacter pylori eradication: a randomized controlled trial (MACLOR study). Arch Intern Med, 2002, 162(2): 153-160.

Chinese Journal of Evidence-Based Medicine

The Furazolidone-based First-line Therapy for Helicobacter Pylori Infection: A Meta-analysis

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