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

Despite the increasing rates of antibiotic resistance, furazolidone-based regimens have demonstrated promise in <i>Helicobacter pylori</i> 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. Patients who received BQFT or BQFA as rescue treatment were enrolled in this study. <i>H. pylori</i> status was determined using the ¹³C/¹⁴C urea breath test or histological examination. Eradication rates, adherence and side effects were carefully recorded. 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%, <i>P</i> &lt; 0.001), suggesting superior efficacy for patients with prior treatment failures. However, BQFA demonstrated fewer overall adverse effects (11.6% vs. 20.7%, <i>P</i> = 0.046), highlighting a tolerability advantage. Both groups showed similar symptom improvements and compliance rates. BQFT exhibits superior efficacy with acceptable tolerability, making it a promising option for patients with refractory <i>H. pylori</i> infections. Clinicians should consider its benefits in cases of multiple prior eradication failures.