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Risk factors of furazolidone-associated fever
Jiali Zhang1, Chunling Rong1, Chenyang Yan2
1Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Background:
Furazolidone is a synthetic nitrofuran with a broad spectrum of antimicrobial action and has been widely used in the treatment of Helicobacter pylori (H. pylori) infection. However, its safety profile has not been clarified. Moreover, the drug fever associated with its use is frequently misdiagnosed. The aim of this study was to explore the risk factors of furazolidone-associated fever to increase awareness and stimulate further research on this topic.
Methods:
This was a retrospective case-control study of patients referred to a specialist clinic for furazolidone-containing quadruple regimens for H. pylori infection at a tertiary care hospital located in Eastern China between July 2018 and September 2018. We evaluated adult patients who received furazolidone treatment for Helicobacter pylori infection. The exclusion criteria were as follows: (1) patients were pregnant or breastfeeding; (2) patients received furazolidone treatment not for Helicobacter pylori infection; (3) patients had taken antibiotics or any acid suppressant or non-steroidal anti-inflammatory drug in the last 4 weeks; (4) patients had chronic hepatic, renal, or pulmonary disease. Pertinent information was retrieved from medical records and telephone follow-up. All statistical analysis was performed in SPSS version 22.0.
Results:
A total of 1499 patients received furazolidone and met the overall inclusion criterion. Of these 1499 patients, 27 (1.80%) developed drug fever. The mean time between initiation of furazolidone and the onset of fever is 11.00 ± 1.84 days, and the median peak fever was 38.87 ± 0.57°C. We found no differences in age and past drug allergy between the non-fever and fever groups. Through multiple logistic regression analysis, we found two variables as independent risk factors for furazolidone-associated fever, including gender (OR, 3.16; 95% CI, 1.26-7.91; P = 0.014) and clarithromycin (OR, 4.83; 95% CI, 2.17-10.79; P<0.001).
Conclusions:
This retrospective cohort study identified two risk factors for furazolidone-associated fever, which were female and clarithromycin. We also analyzed the characteristics of drug fever during anti-Helicobacter pylori therapy. However, the underlying mechanisms are uncertain and require further research.
Insights
Female patients and those taking clarithromycin are at higher risk for drug fever when treated with furazolidone for Helicobacter pylori infection. This finding highlights potential safety concerns and the need for further investigation into furazolidone-associated fever.
Area of Science:
- Pharmacology
- Infectious Diseases
- Clinical Medicine
Background:
- Furazolidone, a nitrofuran, is used for Helicobacter pylori treatment but its safety, particularly drug fever, is not well-defined.
- Drug fever from furazolidone is often misdiagnosed, necessitating research into its risk factors.
- Understanding these risk factors can improve patient safety and guide further research.
Purpose of the Study:
- To identify risk factors associated with furazolidone-induced drug fever in patients treated for H. pylori infection.
- To raise awareness among clinicians regarding potential adverse reactions to furazolidone.
- To provide data for future research on the mechanisms and management of furazolidone-associated fever.
Main Methods:
- A retrospective case-control study was conducted involving adult patients receiving furazolidone-based quadruple therapy for H. pylori.
- Patients were recruited from a tertiary care hospital in Eastern China between July and September 2018.
- Exclusion criteria included pregnancy, breastfeeding, other infections, recent antibiotic/NSAID use, and chronic organ diseases. Data were collected via medical records and phone follow-up.
Main Results:
- Out of 1499 patients, 27 (1.80%) developed drug fever, with onset around 11 days after initiating furazolidone.
- The median peak fever was 38.87°C. No significant differences were observed in age or history of drug allergy between fever and non-fever groups.
- Logistic regression identified female gender (OR, 3.16) and concurrent clarithromycin use (OR, 4.83) as independent risk factors for furazolidone-associated fever.
Conclusions:
- Female sex and concomitant clarithromycin use are significant risk factors for developing drug fever during furazolidone therapy for H. pylori.
- The study characterized drug fever during H. pylori treatment but the underlying mechanisms remain unclear.
- Further research is recommended to elucidate the pathophysiology and improve the safety profile of furazolidone treatment.
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