Furazolidone, amoxycillin, bismuth triple therapy for Helicobacter pylori infection

Abstract

Background: Metronidazole‐resistant Helicobacter pylori are generally the rule in developing countries such as Colombia. Developing countries need an effective, simple and inexpensive non‐metronidazole therapy for H. pylori infection. Aim: To evaluate the combination of bismuth, furazolidone and amoxycillin for the treatment of H. pylori infection in Colombia. Methods: Thirty patients with histologically documented H. pylori infection received the combination of bismuth subcitrate 240 mg b.d., furazolidone 100 mg q.d.s. and amoxycillin 500 mg q.d.s. for 14 days. Four or more weeks after ending therapy patients were re‐endoscoped and gastric biopsies were obtained and examined using the Genta stain. Each slide was scored for presence, absence and density of H. pylori, active and chronic inflammation, intestinal metaplasia, erosions and atrophy. Cure was defined as the absence of H. pylori. Results: All patients completed the course of therapy. Twenty‐five patients were cured (86%, 95% CI: 65–94%). Mild, well‐tolerated side‐effects were reported by six patients (20%). Conclusions: This combination of bismuth, furazolidone and amoxycillin fulfills the criteria for successful H. pylori therapy and appears particularly well suited for developing countries since it is simple, inexpensive and effective. Furazolidone‐containing therapies may become especially useful in the face of a world‐wide increase in H. pylori resistance to metronidazole and macrolides.

Quadruple therapy with furazolidone for retreatment in patients with peptic ulcer disease

“…Asian and European studies have reported a relatively high incidence of adverse effects (31.4%-35%) [10,24,25] . Conversely, two South American [26,27] studies have shown fewer undesirable symptoms when compared to the previously mentioned studies. In the present study, despite a comparable incidence of adverse effects during treatment, only three patients had severe symptoms demanding treatment discontinuation.…”

Pathogenesis and therapy of gastric and duodenal ulcer disease

“…Furazolidone, a monamine oxidase inhibitor, interacts with many drugs and foods. Adverse effects of furazolidone include nausea, vomiting, headache, tachycardia, and hypertension [104,105].…”

Evaluation of Nitrofurantoin Combination Therapy of Metronidazole-Sensitive and -Resistant Helicobacter pylori Infections in Mice

“…Clinical trials have demonstrated that triple therapies involving furazolidone (including omeprazole, clarithromycin, and furazolidone regimens) are able to achieve a high cure rate of H. pylori, and such regimens may prove particularly useful in areas where the prevalence of metronidazole-resistant strains is high (10,33,46,57). The clinical evaluation of nitrofurantoin has been limited to studies in which the agent was given either as monotherapy or in combination with bismuth subsalicylate and not as part of a triple-agent regimen (4,21,24,39,44).…”

“…It was proposed that this enzyme reduces the nitro group of metronidazole to active metabolites that are toxic to the bacterium and that resistance arose from mutational inactivation of the underlying gene, rdxA (HP0954 in the H. pylori genome database [49]). Subsequent studies have suggested that, while the development of metronidazole resistance in H. pylori is highly associated with mutational inactivation of the rdxA gene, other mechanisms of resistance are likely to exist in this bacterium (26,48 The nitrofuran group of compounds, which includes furazolidone and nitrofurantoin, appears a particularly promising source of alternative agents for metronidazole in H. pylori eradication regimens (7,46,57). Like that of the 5-nitroimidazoles, the biological activity of these nitroaromatic compounds is largely derived from reductive metabolism of the parent compound's nitro moiety by oxygen-insensitive nitrore-ductases (2,36,55).…”

“…Like that of the 5-nitroimidazoles, the biological activity of these nitroaromatic compounds is largely derived from reductive metabolism of the parent compound's nitro moiety by oxygen-insensitive nitrore-ductases (2,36,55). A number of recent clinical trials have demonstrated that short-term triple therapies with furazolidone are effective in the treatment of H. pylori infection (10,33,46,57). Based on nitrofurantoin's in vitro activity, there is evidence that it might also be a suitable alternative agent in combination antimicrobial therapy, particularly against metronidazole-resistant H. pylori strains (7).…”