Furazolidone-induced pulmonary toxicity in Helicobacter pylori infection:Two case reports

BACKGROUND Helicobacter pylori(H.pylori)infection is a global problem,causing significant morbidity and mortality.Furazolidone is recommended to eradicate H.pylori infections in China owing to the highly associated antibiotic resistance.CASE SUMMARY This article presents two cases of lung injury caused by furazolidone treatment of H.pylori infection and the relevant literature review.Two patients developed symptoms,including fever,cough,and fatigue after receiving a course of furazolidone for H.pylori infection.Chest computed tomography showed bilateral interstitial infiltrates.Laboratory studies revealed elevated blood eosinophil count.After discontinuing furazolidone with or without the use of corticosteroids,the symptoms improved rapidly.A PubMed database literature search revealed three reported cases of lung injury suggestive of furazolidone-induced pulmonary toxicity.CONCLUSION Clinicians should be aware of the side effects associated with the administration of furazolidone to eradicate H.pylori infection.

Furazolidone,amoxicillin,bismuth and rabeprazole quadruple rescue therapy for the eradication of Helicobacter pylori

AIM： To compare the efficacy and side effect profiles of three furazolidone and amoxicillin-based quadruple rescue therapies for the eradication of Helicobacter pylori （H pylonS. METHODS： Patients who failed in the Hpylori eradication therapy for at least one course were randomly allocated into three groups. Group A received rebaprazole 10 mg＋ amoxicillin 1 g ＋ furazolidone 100 mg, and bismuth subcitrate 220 mg, twice daily for 1 wk; group B received the same regimen of group A but for 2 wk; and group C received the same regimen of group B, but furazolidone was replaced by furazolidone 100 mg three times daily. To record the side effect profiles at the end of the treatment, Hpylori eradication was assessed with 13C-urea breath test 4 wk after therapy. RESULTS： Sixty patients were enrolled including 28 males, and 20 patients in each group. The average age of the patients was 49.2 years, ranging from 18 to 84 years. H pylori eradication rates with per-protocol analysis were 82%, 89% and 90% in the three groups, respectively. Side effects were found in 11 patients, including mild dizziness, nausea, diarrhea and increased bowel movement. None of the 11 patients needed treatment for their side effects. CONCLUSION： One- or two-week furazolidone and amoxicillin-based quadruple rescue therapy with a low dose furazolidone （100 mg bid） for the eradication of Hpylori is effective. Extending the antibiotic course to 14 d could improve the eradication rates.

Outcomes of furazolidone-and amoxicillin-based quadruple therapy for Helicobacter pylori infection and predictors of failed eradication

AIM To evaluate the outcomes of furazolidone-and amoxicillin-based quadruple therapy for treatment of Helicobacter pylori(H. pylori) infection and identify predictors of failed eradication.METHODS Patients with H. pylori infection treated with furazolidone, amoxicillin, bismuth, and proton pump inhibitor therapy(January 2015 to December 2015) who received the ^(13)C-urea breath test > 4 wk after treatment were evaluated. Demographic and clinical data including prior H. pylori treatment attempts, medication adherence, alcohol and cigarette consumption during therapy, and treatment-related adverse events were recorded by reviewing medical records and telephone surveys. H. pylori eradication rates for overall and subgroups were evaluated. Multivariate analysis was performed to identify independent predictors of failed H. pylori eradication.RESULTS Of the 992 patients treated and retested for H. pylori infection, the overall eradication rate was 94.5% [95% confidence interval(CI): 94.1%-95.9%]. H. pylori eradication rate of primary therapy was 95.0%(95%CI: 93.5%-96.5%), while that of rescue therapy was 91.3%(95%CI: 86.8%-95.8%). Among the 859 patients who completed the study protocol, 144(17%) reported treatment-related adverse events including 24(3%) leading to premature discontinuation. On multivariate analysis, poor medication adherence [adjusted odds ratio(AOR) = 6.7, 95%CI: 2.8-15.8], two or more previous H. pylori treatments(AOR = 7.4, 95%CI: 2.2-24.9), alcohol consumption during therapy(AOR = 4.4, 95%CI: 1.5-12.3), and possibly smoking during therapy(AOR = 1.9, 95%CI: 0.9-4.3) were associated with failed H. pylori eradication. CONCLUSION Furazolidone-and amoxicillin-based quadruple therapy for H. pylori infection in an area with a high prevalence of clarithromycin resistance demonstrated high eradication rates as primary and rescue therapies with a favorable safety profile. Patient education targeting abstinence from alcohol during therapy and strict medication adherence may further optimize H. pylori eradication.

Furazolidone-based triple and quadruple eradication therapy for Helicobacter pylori infection

AIM: To evaluate the efficacy of furazolidone-based triple and quadruple therapy in eradicating Helicobacter pylori (H. pylori) in a multi-center randomized controlled trial.

Resistance of Helicobacter pylori to furazolidone and levofloxacin: A viewpoint

In their review, Arslan et al[1] did not describe the status of Helicobacter pylori(H. pylori) treatment with furazolidone and the resistance to this antibiotic. We have presented different surveys showing the resistance of H. pylori to furazolidone from Asia and South America. The resistance rates varied but were mostly low(< 5%). There are not enough data on its efficacy and resistance in the United States and Europe. H. pylori mutations occurring in the oor D gene, including A041 G, A122 G, C349A(G), A78 G, A112 G, A335 G, C156 T and C165 T, and in the por D gene, including G353 A, A356 G, C357 T, C347 T, C347 G and C346 A, have been indicated to be possibly related to the observed resistance. Additionally, to complete Arslan et al 's statement regarding levofloxacin resistance, it should be noted that compound mutations of N87 A, A88 N and V65 I at codon Asn-87 were recently observed in the gyr A gene for the first time. However, the results on these topics are not sufficient, and more worldwide studies are suggested.

Quadruple therapy with furazolidone for retreatment in patients with peptic ulcer disease

AIM: To establish the efficacy and safety of a 7-d therapeutic regimen using omeprazole,bismuth subcitrate,furazolidone and amoxicillin in patients with peptic ulcer disease who had been previously treated with other therapeutic regimens without success.METHODS: Open cohort study which included patients with peptic ulcer who had previously been treated unsuccessfully with one or more eradication regimens.The therapeutic regimen consisted of 20 mg omeprazole,240 mg colloidal bismuth subcitrate,1000 mg amoxicillin,and 200 mg furazolidone,taken twice a day for 7 d.Patients were considered as eradicated when samples taken from the gastric antrum and corpus 12 wk after the end of treatment were negative for Helicobacter pylori (H pylori) (rapid urease test and histology).Safety was determined by the presence of adverse effects.RESULTS: Fifty-one patients were enrolled.The eradication rate was 68.8% (31/45).Adverse effects were reported by 31.4% of the patients,and these were usually considered to be slight or moderate in the majority of the cases.Three patients had to withdraw from the treatment due to the presence of severe adverse effects.CONCLUSION: The association of bismuth,furazolidone,amoxicillin and a proton-pump inhibitor is a valuable alternative for patients who failed to respond to other eradication regimens.It is an effective,cheap and safe option for salvage therapy of positive patients.

Furazolidone therapy for Helicobacter pylori:Is it effective and safe?

Some aspects related with the use of furazolidone as a rescue therapy for Helicobacter pylori （H pylorl） infection should be remarked, especially regarding its potential oncologic risk. The inclusion of furazolidone in a treatment regimen for H pylori infection is, at least, controversial, and it does not appear to be safe.

Design and efficient synthesis of novel haptens and complete antigens for the AOZ,a toxic metabolite of furazolidone

A good strategy was brought forward for designing efficient haptens and complete antigens for 3-amino-2-oxazolidinone （AOZ）. Haptens designed newly were achieved facilely in good yield by using LiCI-N（Et）3 as new catalysis system, the structure of which was elucidated by spectroscopy analysis, such as NMR and MS. Novel antigens for AOZ were prepared successfully by convenient active ester method. The ratios of haptens 3 and 4 to carrier proteins were proven respectively as 41 ： 1 （5a）, 39：1 （6a）, 11：1 （5b） and 9：1 （6b） by trinitrobenzene sulfonic acid （TNBS） method. The results of indirect competitive ELISA （ic-ELISA） of antiserums indicated that the haptens with a short unsaturated side chain can evoke specific immune response effectively.

Furazolidone-based triple therapy for H pylori gastritis in children

AIM： To evaluate the furazolidone-based triple therapy in children with symptomatic H pylori gastdtis. METHODS： A prospective and consecutive open trial was carried out. The study included 38 patients with upper digestive symptoms sufficiently severe to warrant endoscopic investigation. H pylori status was defined based both on histology and on positive ^13C-urea breath test. Drug regimen was a seven-day course of omeprazole, clarithromycin and furazolidone （100 mg, 200 mg if over 30 kg） twice daily. Eradication of H pylori was assessed two months after treatment by histology and ^13C-urea breath test. Further clinical evaluation was performed 7 d, 2 and 6 mo after the treatment. RESULTS： Thirty-eight patients （24 females, 14 males） were included. Their age ranged from 4 to 17.8 （mean 10.9 ± 3.7） years. On intent-to-treat analysis （n = 38）, the eradication rate of H pylori was 73.7% （95% CI, 65.2%-82%） whereas in per-protocol analysis （n = 33） it was 84.8% （95% CI, 78.5%-91%）. All the patients with duodenal ulcer （n = 7） were successfully treated （100% vs 56.2% with antral nodularity）. Side effects were reported in 26 patients （68.4%）, mainly vomiting （14/26） and abdominal pain （n = 13）. Successfully treated dyspeptic patients showed improvement in 78.9% of H pylori-negative patients after six months and in 50% of Hpylori-positive patients after six months of treatment. CONCLUSION： Triple therapy with furazolidone achieves moderate efficacy in H pylori treatment. The eradication rate seems to be higher in patients with duodenal ulcer.

Molecularly imprinted sensor based on carboxylated carbon nanotubes/Keggin-type polyoxometalates nanocomposite for the detection of furazolidone

Due to its properties of mutagenic,teratogenic,and carcinogenic,the detection of furazolidone(FZD)in aquaculture is of great importance for food safety and human health.In this study,molecularly imprinted fi lms modifi ed with carboxylated multi-walled carbon nanotube-phosphomolybdic acid composite were used to fabricate an electrochemical sensor for the determination of FZD.The nanocomposites were characterized using infrared spectroscopy,scanning electron microscopy,energy-dispersive X-ray spectroscopy,and X-ray diff raction.The electrochemical characteristics of the modifi ed electrodes were examined using electrochemical impedance spectroscopy,cyclic voltammetry,and diff erential pulse voltammetry.The sensor exhibited exceptional catalytic performance.The calibration curves were acquired in the concentration range of 6 nmol·L^(−1)to 0.6μmol·L^(−1),with a limit of detection of 3.38 nmol·L^(−1).Additionally,the sensor proved successful in recognizing FZD in shrimp samples with satisfactory recoveries and precision.The method provides a strategy to construct a molecularly imprinted electrochemical sensing platform using nanomaterials,which has great promise in the field of food safety.

Efficacy and safety of modified tetracycline dosing in a quadruple therapy for Helicobacter pylori:A retrospective single center study

BACKGROUND Although highly effective as a component of Helicobacter pylori(H.pylori)treatment regimen,tetracycline is associated with a high incidence of medicationrelated adverse events.Modified dosing of tetracycline as part of quadruple therapy may improve safety while providing comparable eradication rates.AIM To evaluate the efficacy and safety of modified dosing of tetracycline in patients receiving tetracycline and furazolidone-containing quadruple therapy in patients with H.pylori infection.METHODS Consecutive patients(10/2020-12/2021)who received tetracycline and furazolidone quadruple therapy for H.pylori infection at Sir Run Run Shaw Hospital were identified.All patients received tetracycline,furazolidone,proton pump inhibitor,and bismuth for 14 d as primary or rescue therapy.Modified tetracycline dose group received tetracycline 500 mg twice daily while standard group received 750 mg twice daily or 500 mg three times daily.RESULTS Three hundred and ninety-four patients[mean age=46.3±13.9,male=137(34.8%),and 309(78.4%)primary therapy]completed tetracycline and furazolidone quadruple therapy for H.pylori infection including those who received modified tetracycline dose in 157 and standard doses in 118(750 mg twice daily)and 119(500 mg three times daily).Eradication rates in the modified tetracycline dose group were 92.40%and in the standard groups,eradication rates were 93.20%for 750 mg twice daily group and 92.43%for 500 mg three times daily group,respectively,without statistical difference(P=0.959).The incidence of adverse events was lower in the modified tetracycline dose(15.3%vs 32.3%and 29.4%;P=0.002)compared to the standard dose group.CONCLUSION In a real-world experience,modified tetracycline dosing as part of tetracycline and furazolidone quadruple therapy for 14 d demonstrated high efficacy,comparable to standard tetracycline dose regimens,with a favorable safety profile.

UPLC-MS/MS测定鱼干中的呋喃唑酮代谢物

A high performance liquid chromatography-tandem mass spectrometric method was established for determination of the nitrofuran metabolites were released.After adjusting pH range from 7.0 to 7.5. Then the analytes were extracted by ethyl acetate identification was achieved by electrospray ionization in positive mode(ESI+) using multiple reaction monitoring.The quantification was performed with external standards.The recoveries of 3-Amino-2-oxazolidinone(AOZ)were in the range of 79.1%-94.8% with spiked levels of 0.5-2 μg/kg.The RSD were less than 8.23%.The limits of detection were 0.10 μg/kg for AOZ.

Resistance of Helicobacter pylori to antibiotics from 2000 to 2009 in Shanghai

AIM: To investigate the resistance of Helicobacter pylori (H. pylori ) to 6 commonly used antibiotics from 2000 to 2009 in Shanghai. METHODS: A total of 293 H. pylori strains were collected from 2000 to 2009 in Shanghai and tested for their susceptibility to metronidazole, clarithromycin, amoxicillin, furazolidone, levofloxacin and tetracycline using agar dilution. RESULTS: The resistant rates of H. pylori to clarithromycin (8.6%, 9.0% and 20.7%) and levofloxacin (10.3%, 24.0% and 32.5%) increased from 2000 to 2009 in Shanghai. The resistant rate of H. pylori to metronidazole remained stable (40%-50%). Only one strain of H. pylori isolated in 2005 was resistant to tetracycline. All strains were sensitive to amoxicillin and furazolidone.The resistant rate of H. pylori to antibiotics was not related with the sex, age and clinical outcome of patients. CONCLUSION: Resistance of H. pylori to antibiotics plays an important role in making treatment strategies against H. pylori -associated diseases.

Third-line rescue therapy for Helicobacter pylori infection

H pylori gastric infection is one of the most prevalent infectious diseases worldwide. The discovery that most upper gastrointestinal diseases are related to Hpylori infection and therefore can be treated with antibiotics is an important medical advance. Currently, a first-line triple therapy based on proton pump inhibitor （PPI） or ranitidine bismuth citrate （RBC） plus two antibiotics （darithromycin and amoxicillin or nitroimidazole） is recommended by all consensus conferences and guidelines. Even with the correct use of this drug combination, infection can not be eradicated in up to 23% of patients. Therefore, several second line therapies have been recommended. A 7 d quadruple therapy based on PPI, bismuth, tetracycline and metronidazole is the more frequently accepted. However, with second-line therapy, bacterial eradication may fail in up to 40% of cases. When Hpylori eradication is striclly indicated the choice of further treatment is controversial. Currently, a standard third-line therapy is lacking and various protocols have been proposed. Even after two consecutive failures, the most recent literature data have demonsbated that Hpylori eradication can be achieved in almost all patients, even when antibiotic susceptibility is not tested. Different possibilities of empirical treatment exist and the available third-line strategies are herein reviewed.

Quadruple therapy for eradication of Helicobacter pylori

AIM:To investigate quadruple therapy with rabeprazole,amoxicillin,levofloxacin and furazolidone for the eradication of Helicobacter pylori (H.pylori) infection.METHODS:A total of 147 patients were divided into the experimental treatment group (n=78) and the standard triple treatment group (n=69).The experimental treatment group received rabeprazole 20 mg,amoxicillin 1.0 g,levofloxacin 0.2 g and furazolidone 0.1 g,twice daily.The standard triple treatment group received omeprazole 20 mg,amoxicillin 1.0 g and clarithromycin 0.5 g,twice daily.RESULTS:One month after treatment,the 13 C urea breath test was carried out to detect H.pylori.The eradication rate using per-protocol analysis was 94.3% in the experimental treatment group and 73% in the standard triple treatment group (P < 0.05),and using intention to test analysis,these figures were 86% and 67% in the two groups,respectively.Side effects were observed in 34 patients,and included mild dizziness,nausea,diarrhea and increased bowel movement.Eleven of the 34 patients needed no treatment for their side effects.CONCLUSION:Rabeprazole,amoxicillin,levofloxacinand furazolidone quadruple therapy is a safe method for the eradication of H.pylori with high efficacy and good tolerability.