Doxycycline,Furazolidone Quadruple Therapy Vs.Culture-Guided Therapy As Rescue Treatment For Helicobacter Pylori Infection

BACKGROUND AND AIMS:As Helicobacter pylori(H.pylori)resistance has become increasingly prominent,the need for rescue therapies has increased.Although guidelines recommend H.pylori culture and antimicrobial susceptibility testing(AST)to guide rescue treatment,the technical challenges limit the popularity of culture.Tetracycline and furazolidone quadruple therapy had been reported as a promising regimen,but tetracycline caused frequent side effects and became unavailable in many areas.The aim of this study was to compare the efficacy and safety of doxycycline(an alternative in tetracycline class),furazolidone-based quadruple therapy(DFQT)and culture-guided therapy for rescue treatment of H.pylori infection.METHODS:Patients with prior failed H.pylori treatment at Sir Run Run Shaw Hospital(1/2016-5/2019)were reviewed.DFQT group received empiric doxycycline,furazolidone-based 14-day quadruple therapy including bismuth and proton pump inhibitor.Tailored group had H.pylori positive culture and received culture-guided therapy according to the AST results.Treatment outcomes,adverse events and other clinical data were collected by reviewing medical records and telephone surveys.Chi-squared test and Logistic regression models were performed to analyze the statistics.RESULTS:A total of 214 patients were collected,include 135 in DFQT group and 79 in tailored group.The overall eradication rates were 70.4%(95%CI:62.7%-78.7%)in DFQT group vs.86.1%(95%CI:78.4%-93.7%)in tailored group(p＝0.009)Among patients who had one prior treatment failure in DFQT group,the eradication rate was 80%.In multivariate analysis,compared to culture-guided therapy,DFQT(aOR＝4.77,95%CI:2.05-11.11)was an independent factor for eradication failure The number of previous eradication failures is an independent factor responsible for the difference in the eradication rate of DFQT group.Compared to one prior failed treatment,the more failed attempts(twice,aOR = 3.11,95 CI%:1.22-7.92;more than twice,aOR＝6.44,95%CI:1.98-20.95),the more likelihood to fail again.The eradication rate in the tailored group was not significantly related to the number of previous failures.There were no significant differences in side effects between the two groups.CONCLUSIONS:Although empiric DFQT was inferior to culture-guided therapy as rescue treatment for H.pylori infection,patients who had one prior treatment failure could obtain a satisfactory eradication rate by DFQT.It’s necessary to perform H.pylori culture and AST for patients who failed twice or more,and make treatment plans based on AST results.