Zhongguo quanke yixue (Oct 2022)
Efficacy of Rabeprazole Combined with Amoxicillin or Furazolidone Dual Therapy in Eradicating Helicobacter pylori Infection
Abstract
Background Helicobacter pylori (H.pylori) infection is strongly associated with peptic ulcer, gastric cancer, gastric lymphoma, and other diseases. A new dual therapy has proven effective in the eradication of H.pylori, but it has not been verified in some areas with a high prevalence of H.pylori infection in central China. Objective To explore the clinical efficacy of rabeprazole combined with amoxicillin or furazolidone dual therapy in the eradication of H.pylori infection. Methods 161 patients with a first diagnosis of H.pylori infection were recruited from Department of Gastroenterology, Henan Provincial People's Hospital during April 2020 to October 2021, and randomized into three groups with different 14-day therapies: group A (n=55) received a twice-daily quadruple therapy consisting of rabeprazole (20 mg) + bismuth potassium citrate (220 mg) + amoxicillin (1 000 mg) + furazolidone (100 mg) , group B (n=54) received a three-time daily dual therapy consisting of rabeprazole (20 mg) + high-dose amoxicillin (1 000 mg) , and group C (n=52) received a three-time daily dual therapy consisting of rabeprazole (20 mg) + high-dose furazolidone (100 mg) . The eradication rate, side effects and cost-effectiveness ratio were compared among the groups. Results Intention-to-treat analysis (ITT) revealed that, the eradication rates of H.pylori in groups A, B and C were 83.6% (46/55) , 81.5% (44/54) and 48.1% (25/52) , respectively. Per-protocol (PP) analysis found that, the eradication rates of H.pylori in groups A, B and C were 88.5% (46/52) , 83.0% (44/53) and 51.0% (25/49) , respectively. Both analyses demonstrated that groups A, B had higher eradication rates of H.pylori than group C (P<0.016 7) . Based on the PP analysis, the overall incidence of side effects was 24.0% (37/154) , which were mainly manifested as nausea, vomiting, anorexia, abdominal pain, diarrhea, skin rash, palpitation, dizziness and debilitation, with nausea as the most common side effect〔9.7% (15/154) 〕. The incidence of side effects in groups A, B and C was 38.5% (20/52) , 7.5% (4/53) and 26.5% (13/49) , respectively. The incidence of side effects in group B was significantly lower than that in group A or C (P<0.016 7) . Cost-effectiveness ratios in groups A, B, and C were 3.33, 4.17, and 3.78, respectively. Group A had the lowest cost-effectiveness ratio. Conclusion Rabeprazole plus amoxicillin had an effect similar to that of the standard bismuth quadruple regimen in terms of the initial eradication rate of H.pylori, which could be recommended as an alternative for the first-line eradication regimen. In addition, rabeprazole plus furazolidone was not suitable for clinical application due to low eradication rate of H.pylori.
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