Safety of furazolidone-containing regimen in Helicobacter pylori infection: a systematic review and meta-analysis

Objectives Furazolidone containing regimen is effectivefor Helicobacter pylori (H. pylori) infection, but its safetyremains controversial. To assess the safety of furazolidone containing regimenin H. pylori infection.Design A systematic review and meta-analysis.Data sources PubMed, Embase, Cochrane...

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Main Authors: Jing Liu, Yan Zhang, Chuan-Guo Guo, Chao-ran Ji, Yue-yue Li, Jun-yan Qu, Xiuli Zuo
Format: Article
Language:English
Published: BMJ Publishing Group 2020-10-01
Series:BMJ Open
Online Access:https://bmjopen.bmj.com/content/10/10/e037375.full
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author Jing Liu
Yan Zhang
Chuan-Guo Guo
Chao-ran Ji
Yue-yue Li
Jun-yan Qu
Xiuli Zuo
author_facet Jing Liu
Yan Zhang
Chuan-Guo Guo
Chao-ran Ji
Yue-yue Li
Jun-yan Qu
Xiuli Zuo
author_sort Jing Liu
collection DOAJ
description Objectives Furazolidone containing regimen is effectivefor Helicobacter pylori (H. pylori) infection, but its safetyremains controversial. To assess the safety of furazolidone containing regimenin H. pylori 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
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spelling doaj-art-07e5152ec42c4f79b2eb3cf527db22aa2025-08-20T02:26:28ZengBMJ Publishing GroupBMJ Open2044-60552020-10-01101010.1136/bmjopen-2020-037375Safety of furazolidone-containing regimen in Helicobacter pylori infection: a systematic review and meta-analysisJing Liu0Yan Zhang1Chuan-Guo Guo2Chao-ran Ji3Yue-yue Li4Jun-yan Qu5Xiuli Zuo65 Hubei Clinical Center & Key Lab of Intestinal & Colorectal Diseases, Wuhan, Hubei, ChinaDrug Clinical Trial Institution, Shanghai Mental Health Center, Shanghai, ChinaDepartment of Medicine, University of Hong Kong, Hong Kong, ChinaDepartment of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shangdong, ChinaDepartment of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shangdong, ChinaDepartment of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shangdong, ChinaDepartment of Gastroenterology, Qilu Hospital, Shandong University, Jinan, Shandong, People`s Republic of ChinaObjectives Furazolidone containing regimen is effectivefor Helicobacter pylori (H. pylori) infection, but its safetyremains controversial. To assess the safety of furazolidone containing regimenin H. pylori 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 CRD42019137247https://bmjopen.bmj.com/content/10/10/e037375.full
spellingShingle Jing Liu
Yan Zhang
Chuan-Guo Guo
Chao-ran Ji
Yue-yue Li
Jun-yan Qu
Xiuli Zuo
Safety of furazolidone-containing regimen in Helicobacter pylori infection: a systematic review and meta-analysis
BMJ Open
title Safety of furazolidone-containing regimen in Helicobacter pylori infection: a systematic review and meta-analysis
title_full Safety of furazolidone-containing regimen in Helicobacter pylori infection: a systematic review and meta-analysis
title_fullStr Safety of furazolidone-containing regimen in Helicobacter pylori infection: a systematic review and meta-analysis
title_full_unstemmed Safety of furazolidone-containing regimen in Helicobacter pylori infection: a systematic review and meta-analysis
title_short Safety of furazolidone-containing regimen in Helicobacter pylori infection: a systematic review and meta-analysis
title_sort safety of furazolidone containing regimen in helicobacter pylori infection a systematic review and meta analysis
url https://bmjopen.bmj.com/content/10/10/e037375.full
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