Efficacy and safety of tetracycline vs. amoxicillin in furazolidone-based rescue therapy for Helicobacter pylori : a real-world analysis

Background and aim Despite the increasing rates of antibiotic resistance, furazolidone-based regimens have demonstrated promise in Helicobacter pylori 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. H. pylori status was determined using the 13C/14C 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%, P < 0.001), suggesting superior efficacy for patients with prior treatment failures. However, BQFA demonstrated fewer overall adverse effects (11.6% vs. 20.7%, P = 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 H. pylori infections. Clinicians should consider its benefits in cases of multiple prior eradication failures.