Furazolidone versus metronidazole in quadruple therapy for eradication of Helicobacter pylori in duodenal ulcer disease

Abstract

Objective: Furazolidone, an old but cheap antibiotic, was shown to be a good alternative to metronidazole in triple therapy for Helicobacter pylori eradication in areas where metronidazole resistant bacteria are common, but randomized studies are lacking. Aim: A randomized controlled trial to determine the efficacy and safety of furazolidone compared to metronidazole in classic quadruple therapy for eradication of H. pylori infection in duodenal ulcer patients. Methods: Patients with endoscopically proven duodenal ulcer and positive urease test were randomized to receive ranitidine 300 mg, amoxycillin 1000 mg and bismuth subcitrate 240 mg b.d, with either furazolidone 200 mg b.d (RABF), or metronidazole 500 mg b.d. (RABM) for 2 weeks. Compliance and side‐effects were monitored and recorded by table diary. H. pylori eradication was assessed at least 4 weeks after the completion of therapy with 14C‐urea breath test. Results: A total of 106 patients were enrolled and 101 (59 male, 42 female, mean age=40 ± 11 years) completed the study. Endoscopic findings and demographic data were comparable in both groups. Intention‐to‐treat eradication rates were 75% and 55% (P=0.03) and per protocol eradication rates were 82 and 56% (P=0.006) in the RABF and RABM groups, respectively. Side‐effects were reported by 13 patients (27%) in the RABF group (one stopped treatment) compared to five patients (10%) in the RABM group (P=0.04). Conclusion: Quadruple therapy containing furazolidone, instead of metronidazole, results in a significantly higher H. pylori eradication rate in Iranian duodenal ulcer patients.

Furazolidone, amoxicillin and omeprazole with or without bismuth for eradication of Helicobacter pylori in peptic ulcer disease

“…Furazolidone-based combination therapy produced eradication rates around 80% in different studies (8,12,13). Despite this advantage, adverse reactions to furazolidone, which usually occurred in the second week of treatment and led to interruption of the treatment in many instances, limit its use (11,14).…”

“…According to recent studies from our country, furazolidone may be used as an alternative to metronidazole (7,8). Furazolidone offer the advantage of low cost, but unfortunately, more adverse effects influence the drug efficacy (9,10).…”

The Effect of Oral Administration of Pistacia Atlantica Kurdica Gum on the Eradication of Helicobacter Pylori in Patients with Dyspepsia: A Randomized Clinical Trial

“…The second pattern has seen in developed countries where infection increases from the age of 20 and affects about 40% of the adult population (Perez-Perez et al, 2004). In different regions of Iran, the prevalence of H. pylori in adults older than 35 years have been reported nearly 90% (Malekzadeh et al, 2000). However, it seems that the prevalence of H. pylori infection is declining in recent decades and is expected to decrease up to 25% in European countries (Magalhães Queiroz & Luzza, 2006), since H. pylori are the main cause of a wide range of gastric pathologies such as ulcer, gastric lymphoma, and adenocarcinoma, treating the infections caused by it are considered as a major problem (Ernst & Gold, 2000).…”

Helicobacter pylorieradication in West Asia: A review

“…Out of nine 7-, 10-and 14-d Bismuth plus Metronidazole-containing quadruple regimens in Iran, none had acceptable eradication rates [20,22,26,[47][48][49][50][51][52] (Table 2). Besides, only one of the 9 studies conducted in Turkey had 90.1% PP eradication rate (Table 3) [30,[34][35][36][53][54][55][56][57] .…”

“…Furazolidone has been used in nine quadruple therapies in Iran [23,27,[47][48][49][78][79][80][81] , four of which showed optimal efficacy, although severe side effects were reported in 14-d regimens. Low dose Furazolidone was used in a further study, which led to significant decline in eradication rate [80] .…”