Review

Authors: Natsuda Aumpan, Varocha Mahachai, Ratha-Korn Vilaichone...

infection exhibits a wide disease spectrum ranging from asymptomatic gastritis, peptic ulcer disease, to gastric cancer. can induce dysbiosis of gastric microbiota in the pathway of carcinogenesis and successful eradication can restore gastric homeostasis. Diagnostic testing and treatment for infection is recommended in patients with active or past history of peptic ulcer, chronic dyspepsia, chronic non-steroidal anti-inflammatory drugs (NSAID) or aspirin use, precancerous gastric lesions, gastric cancer, mucosa-associated lymphoid tissue (MALT) lymphoma, family history of gastric cancer, family history of peptic ulcers, household family member having active infection, iron deficiency anemia, idiopathic thrombocytopenic purpura, or vitamin B12 deficiency. Recommended first-line regimens for eradication are classified according to clarithromycin resistance. In areas of high clarithromycin resistance (≥15%), we recommend 14-day concomitant therapy or 14-day bismuth quadruple therapy (BQT) as first-line regimen. In areas of low clarithromycin resistance (<15%), we recommend 14-day triple therapy or 14-day BQT as first-line treatment. Second-line regimens are 14-day levofloxacin triple therapy or 14-day BQT if BQT is not previously used. For patients with multiple treatment failure, antimicrobial susceptibility testing (AST) should be performed. If AST is not available, we recommend using antibiotics not previously used or for which resistance is unlikely, such as amoxicillin, tetracycline, bismuth, or furazolidone. High-dose potent proton pump inhibitor or vonoprazan is recommended to achieve adequate acid suppression. Probiotics can be used as an adjuvant treatment to reduce the side effects of antibiotics and enhance eradication rate.

PubMed: 36660052
DOI: 10.1002/jgh3.12843

Review

Authors: Yi Hu, Yin Zhu, Nong-Hua Lu...

() is a common gastrointestinal bacterial strain closely associated with the incidence of chronic gastritis, peptic ulcers, gastric mucosa-associated lymphoid tissue lymphoma, and gastric cancer. A current research and clinical challenge is the increased rate of antibiotic resistance in , which has led to a decreased eradication rate. In this article, we review recent infection and reinfection rates and resistance to antibiotics, and we discuss the pertinent treatments. A PubMed literature search was performed using the following keywords: , infection, reinfection, antibiotic resistance, bismuth, proton pump inhibitors, vonoprazan, susceptibility, quintuple therapy, dual therapy, and probiotic. The prevalence of has remained high in some areas despite the decreasing trend of prevalence observed over time. Additionally, the reinfection rate has varied in different countries due to socioeconomic and hygienic conditions. monoresistance to clarithromycin, metronidazole or levofloxacin was common in most countries. However, the prevalence of amoxicillin and tetracycline resistance has remained low. Because infection and reinfection present serious challenges and because resistance to clarithromycin, metronidazole or levofloxacin remains high in most countries, the selection of an efficient regimen to eradicate is critical. Currently, bismuth-containing quadruple therapies still achieve high eradication rates. Moreover, susceptibility-based therapies are alternatives because they may avoid the use of unnecessary antibiotics. Novel regimens, e.g., vonoprazan-containing triple therapies, quintuple therapies, high-dose dual therapies, and standard triple therapies with probiotics, require further studies concerning their efficiency and safety for treating .

Topics: Amoxicillin; Anti-Bacterial Agents; Bismuth; Clarithromycin; Drug Resistance, Bacterial; Drug Therapy, Combination; Furazolidone; Helicobacter Infections; Helicobacter pylori; Humans; Levofloxacin; Metronidazole; Mutation; Prevalence; Probiotics; Proton Pump Inhibitors; Pyrroles; Rifabutin; Sulfonamides; Tetracycline; Tetracycline Resistance

PubMed: 28529929
DOI: 10.3389/fcimb.2017.00168

Randomized Controlled Trial

Authors: Cong He, Yong Xie, Yin Zhu...

BACKGROUND

() eradication has been reported to cause short-term disruption of gut microbiota. It is acknowledged that probiotics supplementation mitigates side effects induced by eradication, yet its role on alleviating dysbiosis of microbiota is obscure.

OBJECTIVES

To evaluate the impact of probiotics on gastrointestinal microbiota after eradication therapy.

METHODS

This was a multicenter, double-blinded, randomized trial done at seven centers in China. A total of 276 treatment-naïve -positive patients were randomly assigned to receive 14-day bismuth-containing quadruple therapy (esomeprazole, bismuth, amoxicillin, furazolidone) combined with probiotics (Bifidobacterium Tetragenous viable Bacteria Tablets) (n=140) or placebo (n=136) for 28 days. Saliva, gastric mucosa and fecal samples were collected before and after therapy for 16S rRNA gene sequencing.

RESULTS

The incidence of gastrointestinal adverse events was lower in probiotics group compared to placebo group (23.6% vs 37.7%, p=0.016), while there was no significant difference in eradication rate. We found dramatic perturbations of gut microbiota immediately following eradication, with the predominance of Proteobacteria in replacement of commensal Firmicutes and Bacteroidetes, and gradually restored after two weeks. The reduction of gut Bacteroidetes caused by eradication drugs was neutralized with probiotics supplementation. The gastric microbiota was completely reconstituted with depleted and other taxa flourished. Of note, patients treated with probiotics showed smaller fluctuations of gastric microbiota compared to those with placebo. We also observed changes of saliva microbiota after eradication, illustrated by the overgrowth of and depletion of . The expansion of some pathogenic genera, including , , in the mouth was suppressed by probiotics.

CONCLUSION

This study not only demonstrated the beneficial effect of probiotics implementation on side events during eradication but also provided a comprehensive profile of microbiome alterations along gastrointestinal tract that modulated by probiotics.

Topics: Humans; Helicobacter pylori; Gastrointestinal Microbiome; Helicobacter Infections; Bismuth; RNA, Ribosomal, 16S; Anti-Bacterial Agents; Probiotics; Bacteroidetes

PubMed: 36426355
DOI: 10.3389/fimmu.2022.1033063

Review

Authors: M S Wolfe

Giardiasis is one of the most common pathogenic intestinal protozoal infections worldwide. Giardia lamblia is the most frequently identified etiologic agent in outbreaks associated with the ingestion of surface water, often due to ineffective filtration or pretreatment. In addition to humans, other sources of infection include beavers, perhaps muskrats, and possibly domestic animals. A low infecting dose (10 to 25 cysts) is reported to be sufficient to produce human infection. Clinical manifestations range from asymptomatic to a transient or persistent acute stage, with steatorrhea, intermittent diarrhea, and weight loss, or to a subacute or chronic stage that can mimic gallbladder or peptic ulcer disease. Diagnosis is usually based on repeated stool examinations but examination of duodenal fluid or biopsy material may also be necessary. Enzyme immunoassay or indirect immunofluorescence methods for direct detection of antigen or whole organisms in clinical specimens have also been developed. These tests are reported to be more sensitive than routine stool examination. Demonstration of serum immunoglobulin M and G antibodies may help differentiate recent from past infection or help detect recurrence in individuals who have been treated previously. Serum immunoglobulin A levels may be a useful indicator of exposure in waterborne outbreaks of diarrhea. Drugs available for treatment within the United States include metronidazole, quinacrine hydrochloride, and furazolidone.

Topics: Animals; Giardiasis; Humans

PubMed: 1735095
DOI: 10.1128/CMR.5.1.93

Comparative Study

Authors: Jinliang Xie, Jianxiang Peng, Shuang Wu...

BACKGROUND AND AIM

Despite the increasing rates of antibiotic resistance, furazolidone-based regimens have demonstrated promise in eradication. Therefore, this study aims to evaluate the comparative efficacy and safety of tetracycline versus amoxicillin in furazolidone-based quadruple therapy [bismuth quadruple therapy with furazolidone and tetracycline (BQFT) vs. bismuth quadruple therapy with furazolidone and amoxicillin (BQFA)] in rescue treatments.

METHODS

Patients who received BQFT or BQFA as rescue treatment were enrolled in this study. status was determined using the C/C urea breath test or histological examination. Eradication rates, adherence and side effects were carefully recorded.

RESULTS

A total of 342 participants were included. BQFT showed significantly higher eradication rates (modified intention-to-treat: 96.2% vs. 76%; per-protocol: 97.1% vs. 77.8%,  < 0.001), suggesting superior efficacy for patients with prior treatment failures. However, BQFA demonstrated fewer overall adverse effects (11.6% vs. 20.7%,  = 0.046), highlighting a tolerability advantage. Both groups showed similar symptom improvements and compliance rates.

CONCLUSION

BQFT exhibits superior efficacy with acceptable tolerability, making it a promising option for patients with refractory infections. Clinicians should consider its benefits in cases of multiple prior eradication failures.

Topics: Humans; Furazolidone; Helicobacter Infections; Amoxicillin; Male; Female; Helicobacter pylori; Tetracycline; Middle Aged; Anti-Bacterial Agents; Drug Therapy, Combination; Adult; Treatment Outcome; Aged; Bismuth

PubMed: 39950212
DOI: 10.1080/07853890.2025.2464938

Authors: Jiali Zhang, Chunling Rong, Chenyang Yan...

BACKGROUND

Furazolidone is a synthetic nitrofuran with a broad spectrum of antimicrobial action and has been widely used in the treatment of Helicobacter pylori (H. pylori) infection. However, its safety profile has not been clarified. Moreover, the drug fever associated with its use is frequently misdiagnosed. The aim of this study was to explore the risk factors of furazolidone-associated fever to increase awareness and stimulate further research on this topic.

METHODS

This was a retrospective case-control study of patients referred to a specialist clinic for furazolidone-containing quadruple regimens for H. pylori infection at a tertiary care hospital located in Eastern China between July 2018 and September 2018. We evaluated adult patients who received furazolidone treatment for Helicobacter pylori infection. The exclusion criteria were as follows: (1) patients were pregnant or breastfeeding; (2) patients received furazolidone treatment not for Helicobacter pylori infection; (3) patients had taken antibiotics or any acid suppressant or non-steroidal anti-inflammatory drug in the last 4 weeks; (4) patients had chronic hepatic, renal, or pulmonary disease. Pertinent information was retrieved from medical records and telephone follow-up. All statistical analysis was performed in SPSS version 22.0.

RESULTS

A total of 1499 patients received furazolidone and met the overall inclusion criterion. Of these 1499 patients, 27 (1.80%) developed drug fever. The mean time between initiation of furazolidone and the onset of fever is 11.00 ± 1.84 days, and the median peak fever was 38.87 ± 0.57°C. We found no differences in age and past drug allergy between the non-fever and fever groups. Through multiple logistic regression analysis, we found two variables as independent risk factors for furazolidone-associated fever, including gender (OR, 3.16; 95% CI, 1.26-7.91; P = 0.014) and clarithromycin (OR, 4.83; 95% CI, 2.17-10.79; P<0.001).

CONCLUSIONS

This retrospective cohort study identified two risk factors for furazolidone-associated fever, which were female and clarithromycin. We also analyzed the characteristics of drug fever during anti-Helicobacter pylori therapy. However, the underlying mechanisms are uncertain and require further research.

Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Case-Control Studies; Clarithromycin; Drug Therapy, Combination; Female; Furazolidone; Helicobacter Infections; Helicobacter pylori; Humans; Retrospective Studies; Risk Factors; Treatment Outcome

PubMed: 35395029
DOI: 10.1371/journal.pone.0266763

Authors: Zinan Zhang, Fen Liu, Feiyan Ai...

Vonoprazan (VPZ) produces a strong acid-inhibitory effect, which can potentially eradicate . We aimed to assess whether a 14-day VPZ-containing triple therapy was safe and effective in the Chinese population and the potential mechanism. Enrolled patients confirmed to be infected with were randomly divided into four groups: VPZ + doxycycline + furazolidone, VPZ + doxycycline + amoxicillin, esomeprazole (EPZ) + bismuth + doxycycline + furazolidone, and EPZ + colloidal bismuth + doxycycline + amoxicillin for 14 days. The eradication rate, medication adherence, and incidence of adverse events (AEs) were evaluated. Inhibition of by VPZ and EPZ was assessed. treated with appropriate concentrations of VPZ and EPZ were sequenced by transcriptome analysis to explore the antibacterial mechanism. A higher eradication rate were observed in VPZ-containing triple therapy. No obvious differences were observed in medication adherence or the incidence of AEs. VPZ had no direct inhibitory effect on , whereas EPZ directly inhibited may through downregulated genes related to the ribosome. In the Chinese population, 14-day VPZ-containing triple therapy was safe and more effective and can be used clinically as first-line treatment. ClinicalTrials.gov, identifier NCT05097846.

PubMed: 37214450
DOI: 10.3389/fphar.2023.1143969

Authors: Qin Chen, Kelei Zhao, Heyue Li...

BACKGROUND

Trueperella pyogenes and Pseudomonas aeruginosa are two important bacterial pathogens closely relating to the occurrence and development of forest musk deer respiratory purulent disease. Although T. pyogenes is the causative agent of the disease, the subsequently invaded P. aeruginosa will predominate the infection by producing a substantial amount of quorum-sensing (QS)-controlled virulence factors, and co-infection of them usually creates serious difficulties for veterinary treatment. In order to find a potential compound that targets both T. pyogenes and P. aeruginosa, the antibacterial and anti-virulence capacities of 55 compounds, which have similar core structure to the signal molecules of P. aeruginosa QS system, were tested in this study by performing a series of in vitro screening experiments.

RESULTS

We identified that furazolidone could significantly reduce the cell densities of T. pyogenes in mono-culture or in the co-culture with P. aeruginosa. Although the growth of P. aeruginosa could also be moderately inhibited by furazolidone, the results of phenotypic identification and transcriptomic analysis further revealed that sub-inhibitory furazolidone had remarkable inhibitory effect on the biofilm production, motility, and QS system of P. aeruginosa. Moreover, furazolidone could efficiently protect Caenorhabditis elegans models from P. aeruginosa infection under both fast-killing and slow-killing conditions.

CONCLUSIONS

This study reports the antibacterial and anti-virulence abilities of furazolidone on T. pyogenes and P. aeruginosa, and provides a promising strategy and molecular basis for the development of novel anti-infectious drugs to dealing with forest musk deer purulent disease, or other diseases caused by T. pyogenes and P. aeruginosa co-infection.

Topics: Animals; Anti-Bacterial Agents; Biofilms; Deer; Furazolidone; Pseudomonas aeruginosa; Quorum Sensing; Virulence; Virulence Factors

PubMed: 35331229
DOI: 10.1186/s12917-022-03216-5

Review

Authors: T B Gardner, D R Hill

Giardia lamblia is both the most common intestinal parasite in the United States and a frequent cause of diarrheal illness throughout the world. In spite of its recognition as an important human pathogen, there have been relatively few agents used in therapy. This paper discusses each class of drugs used in treatment, along with their mechanism of action, in vitro and clinical efficacy, and side effects and contraindications. Recommendations are made for the preferred treatment in different clinical situations. The greatest clinical experience is with the nitroimidazole drugs, i.e., metronidazole, tinidazole, and ornidazole, which are highly effective. A 5- to 7-day course of metronidazole can be expected to cure over 90% of individuals, and a single dose of tinidazole or ornidazole will cure a similar number. Quinacrine, which is no longer produced in the United States, has excellent efficacy but may be poorly tolerated, especially in children. Furazolidone is an effective alternative but must be administered four times a day for 7 to 10 days. Paromomycin may be used during early pregnancy, because it is not systematically absorbed, but it is not always effective. Patients who have resistant infection can usually be cured by a prolonged course of treatment with a combination of a nitroimidazole with quinacrine.

Topics: Animals; Antiprotozoal Agents; Bacitracin; Benzimidazoles; Feces; Female; Furazolidone; Giardia; Giardiasis; Humans; Lactation; Male; Microscopy, Electron, Scanning; Nitroimidazoles; Paromomycin; Pregnancy; Pregnancy Complications, Parasitic; Quinacrine; Time Factors; Treatment Outcome

PubMed: 11148005
DOI: 10.1128/CMR.14.1.114-128.2001

Meta-Analysis

Authors: Chao-Ran Ji, Jing Liu, Yue-Yue Li...

OBJECTIVES

Furazolidone containing regimen is effectivefor () infection, but its safetyremains controversial. To assess the safety of furazolidone containing regimenin infection.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

PubMed, Embase, Cochrane Library, Web of Science and Scopus databases were systematically searched for eligible randomised controlled trials.

ELIGIBILITY CRITERIA

Studies comparing furazolidone with non-furazolidone-containing regimen, variable durations or doses of furazolidone were included.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently selected studies and extracted data. Primary outcomes were the risk of total adverse events (AEs), serious AEs and severe AEs, expressed as relative risk (RR) with 95% CI. Secondary outcomes contained the incidence of individual adverse symptoms, AE-related treatment discontinuation and compliance.

RESULTS

Twenty-six articles were identified from 2039 searched records, of which 14 studies (n=2540) compared furazolidone with other antibiotics. The eradication rates of furazolidone-containing regimen were higher than those of other antibiotics in both intention-to-treat (RR 1.06, 95% CI 1.01 to 1.12) and per-protocol analysis (RR 1.05, 95% CI 1.00 to 1.10). Only two serious AEs were reported in furazolidone group (2/1221, 0.16%). No significant increased risk was observed for the incidence of total AEs (RR 1.04, 95% CI 0.89 to 1.21) and severe AEs (RR 1.81, 95% CI 0.91 to 3.60). Twelve studies (n=3139) compared different durations of furazolidone, and four studies (n=343) assessed variable doses. Elevated risk of total AEs and severe AEs were only found in a high daily dose of furazolidone rather than prolonged duration. The incidence of AE-related treatment discontinuation and compliance of patients were all similar, irrespective of dose and duration adjustments.

CONCLUSION

Furazolidone-containing regimen has a similar risk of AEs and compliance as non-furazolidone-containing regimen. A low daily dose of 200 mg is well-tolerated for 14 day regimen and should be first considered.

PROSPERO REGISTRATION NUMBER

CRD42019137247.

Topics: Anti-Bacterial Agents; Drug Therapy, Combination; Furazolidone; Helicobacter Infections; Helicobacter pylori; Humans

PubMed: 33077561
DOI: 10.1136/bmjopen-2020-037375