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-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.METHODS: A total of 720 H. pylori positive patients with duodenal ulcer disease were enrolled at 10 different hospitals in Jiangxi province in China. The patients were randomly assigned to four treatment groups as follows: patients in Groups 1 and 3 received rabeprazole(10 mg), amoxicillin(1000 mg) and furazolidone(100 mg) twice daily for 7 and 10 d, respectively; patients in Groups 2 and 4 received rabeprazole(10 mg), bismuth(220 mg), amoxicillin(1000 mg) and furazolidone(100 mg) twice daily for 7 and 10 d, respectively. The primary outcome measure was H. pylori eradication rate 4 wk after treatment by intention-to-treat and per protocol analysis, while the secondary outcome measures were symptom and sign changes at the end of treatment and 4 wk after the end of treatment, as well as the proportion of patients who developed adverse events.RESULTS: The demographic data of the four groups were not significantly different. Overall, 666 patients completed the scheme and were re-assessed with the 13C-urea breath test. The intention-to-treat analysis of the H. pylori eradication rates in Groups 1, 2, 3 and 4 were 74.44%, 82.78%, 78.89% and 86.11%, respectively. The H. pylori eradication rate in Group 4 was significantly higher than that in Group 1. According tothe per protocol analysis, the H. pylori eradication rates in Groups 1, 2, 3 and 4 were 81.21%, 89.22%, 85.54% and 92.26%, respectively. The H. pylori eradication rate in Group 4 was significantly higher than that in Group 1. The number of adverse events was 15(8.3%), 16(8.9%), 15(8.3%) and 17(9.4%) in Groups 1, 2, 3 and 4, respectively, including dizziness, vomiting, diarrhea, nausea, skin rash, itchy skin, and malaise. The symptoms were relieved without special treatment in all of the patients.CONCLUSION: Both 7- and 10-d quadruple furazolidone-based therapies achieve satisfactory H. pylori 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.

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.

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.

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.

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.