Comparison The Efficacy Of Furazolidone-based Vs Clarithromycin-based Quadruple Therapy In Initial Treatment For Helicobacter Pylori Infection

AimEradication of Helicobacter pylori(H.pylori)is the most effective way to treat chronic gastritis,peptic ulcer and prevent gastric cancer.However,the decreased eradication rate and increasing drug resistant pose to be a problem in population-based clinical practice,therefore,selection of proper treatment regimen with high eradication rate and fewer drug resistant is of critically important.Furazolidone(FZD)based quadruple therapy has recently been shown to treat H.pylori infection with relatively low cost and high eradication rate.We evaluate the cost-effectiveness of FZD-based quadruple therapy and compare it with routine larithromycin-based quadruple therapy,in order to seek for the best treatment for eradicating H.pylori in Henan province.MethodsDuring the period from October 2015 to May 2017,200 cases of H.pylori-positive patients receiving initial treatment,with upper gastrointestinal symptoms and in line with the inclusion criteria,confirmed by the endoscopicpathology or 13 C,14C-urea breath test in Henan Province People's Hospital,were randomly allocated into two groups.100 patients were treated with FZD(100 mg,bid)plus esomeprazole(20 mg,bid),bismuth potassium citrate(220 mg,bid)and amoxicillin(1000 mg,bid)for 14 days;100 cases as control were treated with above drugs for 14 days except FZD were replaced by clarithromycin(CLA,500 mg,bid).A patient survey record table was made,and adverse drug reactions and clinical symptoms improvement were recorded through the outpatient or telephone follow-up during the treatment.All patients received 13C-UBE test four weeks post treatment to confirm Hp eradication.Eradication rate,drug's side effects,symptom remission and cost-effectiveness ratio of the two groups were compared,and factors influencing the failure rate of H.pylori eradication was Analyzed.Results1 On intention-to-treat analysis,H.pylori eradication rates in FZD and CLA groups were 83.0%(95%CI:75.5% ~ 90.5%),80.0%(95%CI : 72.0% ~ 88.0%)respectively.On per protocol analysis,their eradication rate were 93.3%(95%CI:87.9%~98.6%),87.9%(95%CI:81.1%~94.7%)respectively.According to ITT or PP,there was no significant difference between the two groups in the eradication rate of H.pylori(P>0.05).2 The drug's side effects occurred in 32 patients(32/200,16.0%),they included nausea,diarrhea,abdominal pain,rash,and oral odor.The incidence of side effects in FZD and CLA groups were 18.0%(18/100)and 14.0%(14/100),no significant difference were detected(P =0.440).3 Remission rate of clinical symptoms in two groups were 95.5% and 94.5%(P>0.05).4 Cost-effectiveness ratios of FZD and CLA groups were 5.5 and 7.4,and incremental cost-effectiveness ratio of the FZD group over the control group was-18.3.5 Gender,age,BMI,smoking,alcohol consumption,educational level,urban-rural distribution and disease status had no effect on the eradication rate ofH.pylori(P>0.05).ConclusionFurazolidone-based and clarithromycin-based quadruple 14-day therapy can achieve good eradication efficacy for the treatment of H.pylori infection,and have high safety.But the former has a relatively high eradication rate and low cost,to some extent,it has clinical significance in guiding the selection of H.pylori eradication programs in our province.