Abstract
Background/Aim: In developing countries the standard quadruple therapy containing metronidazole results in suboptimal eradication rates of Helicobacter pylori (<75%). In a retrospective study, we undertook to evaluate efficacy and tolerability of a furazolidone-based regimen (omeprazole, furazolidone, bismuth, and tetracycline) in patients who had previously failed the standard metronidazole-based regimen (omeprazole, metronidazole, bismuth, and amoxicillin). Methods: The records of H. pylori infected patients who were referred to outpatient clinic (from March 1999 to August 1999) and who underwent previous eradication regimens were studied. A total of 320 cases were noted to have received a metronidazole-based quadruple regimen. From these 320 patients, 80 were noted to have failed this regimen based on a urea breath test. These 80 patients were enrolled in the study and given the furazolidone-based regimen. Side effects were assessed at follow-up visits. At least 2 months after the end of each therapy regimen, a 14C-urea test was performed in each subject to document the cure of the patients. Results: A total of 80 patients (39 males and 41 females) with a mean age of 43.8 ± (SD) 13.3 years were studied. The H. pylori eradication rate was 90% with the furazolidone-based regimen. The side effects of this regimen were minor. Conclusions: A furazolidone-based regimen is effective in patients who do not achieve cure of H. pylori infection with the metronidazole-based quadruple therapy. In areas where the metronidazole resistance is high, initial therapy with a furazolidone-based regimen is recommended.
Journal Section:
Original Paper: <i>Helicobacter pylori</i>
References
1.
Bassa D, Navaglia F, Brigato L, et al: Analysis of H. pylori vacA and cagA genotypes and serum antibody profile in benign and malignant gastroduodenal diseases. Gut 1998;43:182–186.
[PubMed]
2.
Xia HX, Buckley M, Hyde D: Effects of antibiotic resistance on clarithromycin-combined triple therapy for Helicobacter pylori (abstracts). Gut 1995;37(suppl):55.
3.
Malfertheiner P: Compliance, adverse events and antibiotic resistance in Helicobacter pylori treatment. Scand J Gastroenterol 1993;196(suppl):34–37.
4.
Goddard A, Logan R: One week low-dose triple therapy: New standards for Helicobacter pylori treatment. Eur J Gastroenterol Hepatol 1995;7:1–3.
[PubMed]
5.
Guay DRP, Gilberstadt SJ: Antimicrobial management of Helicobacter pylori infection. Arch Fam Med 1997;6:173–180.
[PubMed]
6.
Osato MS, Reddy R, Graham DY: Metronidazole and clarithromycin resistance among H. pylori isolates from a large hospital in the United States (abstract). Gastroenterology 1997;112:105.
7.
Reddy R, Osato M, Gutierrez O: Metronidazole resistance is high in Korea and Columbia and appears to be rapidly increasing in the U.S. (abstract). Gastroenterology 1996;110:236.
8.
Graham DY, Malaty HM, Evans DD, et al: Epidemiology of Helicobacter pylori in an asymptomatic population in the United States; Effect of age, race, and socioeconomic status. Gastroenterology 1991;100:1495–1501.
[PubMed]
9.
Saberi-Firoozi M, Massarrat S, Zare S, et al: Effect of triple therapy or amoxicillin plus omeprazole or amoxicillin plus tinidazole plus omeprazole on duodenal ulcer healing, eradication of Helicobacter pylori, and prevention of ulcer relapse over a 1-year follow-up period: A prospective, randomized, controlled study. Am J Gastroenterol 1995;90:1416–1423.
10.
Graham DY, de Boer WA, Tytgat GN: Choosing the best anti-Helicobacter pylori therapy: Effect of antimicrobial resistance. Am J Gastroenterol 1996;94:1072–1076.
11.
de Boer W, Driessen W, Jansz A, et al: Effect of acid suppression on efficacy of treatment for H. pylori infection. Lancet 1995;345:817–820.
[PubMed]
12.
Xiao SD, Liu WZ, Hu PJ, et al: High cure rate of Helicobacter pylori infection using tripotassium dicitrato bismuthate, flurazolidone and clarithromycin triple therapy for 1 week. Aliment Pharmacol Ther 1999;13:311–315.
[PubMed]
13.
Liu WZ, Xiao SD, Shi Y, et al: Furazolidone-containing short-term triple therapies are effective in the treatment of Helicobacter pylori infection. Aliment Pharmacol Ther 1999;13:317–322.
[PubMed]
14.
Dani R, Queiyoz DM, Dias MG, et al: Omeprazole, clarithromycin and furazolidone for the eradication of Helicobacter pylori in patients with duodenal ulcer. Aliment Pharmacol Ther 1999;13:1647–1652.
[PubMed]
15.
Raju GS, Smith MJ, Morton D, et al: Mini-dose 14C-urea breath test for the detection of Helicobacter pylori. Am J Gastroenterol 1994;89:1027–1031.
[PubMed]
16.
The European Helicobacter Pylori Study Group: Current European concepts in the management of Helicobacter pylori infection. The Maastricht Consensus Report. Gut 1997;41:8–13.
[PubMed]
17.
Graham DY, Osato MS, Hoffman S, et al: Furazolidone combination therapies for Helicobacter pylori infection in the United States. Aliment Pharmacol Ther 2000;14:211–215.
[PubMed]
18.
Sato MS, Reddy R, Graham DY: Metronidazole and clarithromycin resistance among Helicobacter pylori isolates from a large hospital in the United States (abstract). Gastroenterology 1997;112:105.
19.
Lambert JR, Taupin D, Yeomans N, et al: Randomized controlled study on the effect of omeprazole with amoxicillin in Helicobacter pylori eradication (abstract). J Gastroenterol Hepatol 1994;9:96.
20.
Kashifard M, Malekzadeh R, Siavoshi F, et al: Continuous and more effective duodenal ulcer healing under therapy with bismuth and two antibiotics than with dual therapy comprising omeprazole and amoxicillin. Eur J Gastroenterol Hepatol 1998;10:847–850.
[PubMed]
21.
Sotudehmanesh R, Malekzadeh R, Massarrat S, et al: A randomized controlled comparison of three quadruple therapy regimens in a population with low Helicobacter pylori eradication rate. J Gastroenterol Hepatol 2001;16:264–268.
[PubMed]
22.
Salman RH, Massarrat S, Pahliwanzadeh MR, et al: Effect of two different doses of metronidazole and tetracycline in bismuth triple therapy on eradication of H. pylori and its resistant strains. Eur J Gastroenterol Hepatol 1999;11:1–4.
[PubMed]
23.
de Boer WA, Tytgat GN: How to treat Helicobacter pylori infection: Should treatment strategies be based on testing bacterial susceptibility? A personal viewpoint. Eur J Gastroenterol Hepatol 1996;8:709–716.
[PubMed]
24.
Graham DY, Hoffman J, el-Zimaity HM, et al: Twice a day quadruple therapy (bismuth subcitrate, tetracycline, metronidazole plus lansoprazole) for treatment of Helicobacter pylori infection. Aliment Pharmacol Ther 1997;11:935–938.
[PubMed]
25.
Lerang F, Moum B, Haug JB, et al: Highly effective second-line anti-Helicobacter pylori therapy in patients with previously failed metronidazole-based therapy. Scand J Gastroenterol 1997;32:1209–1214.
[PubMed]
26.
Forne M, Viver JM, Esteve M, et al: Randomized clinical trial comparing two one-week triple-therapy regimens for the eradication of Helicobacter pylori infection and duodenal ulcer healing. Am J Gastroenterol 1998;93:35–38.
[PubMed]
27.
Hardy DJ, Hanson CW, Hensey DM, et al: Susceptibility of Campylobacter pylori to macrolides and fluoroquinolones. J Antimicrob Chemother 1988;22:631–636.
[PubMed]
28.
Teare JP, Booth JC, Brown JL, et al: Pseudomembranous colitis following clarithromycin therapy. Eur J Gastroenterol Hepatol 1995;7:275–277.
[PubMed]
29.
Fakheri H, Malekzadeh, Merat S, et al: Clarithromycin vs. furazolidone in quadruple therapy regimens for the treatment of Helicobacter pylori in a population with a high metronidazole resistance rate. Aliment Pharmacol Ther 2001;15:411–416.
[PubMed]
30.
White AH: Absorption, distribution, metabolism, and excretion of furazolidone: A review of the literature. Scand J Gastroenterol Suppl 1989;169:4–10.
[PubMed]
31.
Zhen ZT, Wang YB: Treatment of peptic ulcer disease with furazolidone. J Gastroenterol Hepatol 1992;7:533–537.
[PubMed]
32.
Zheng ZT, Wang ZY, Chu YX, et al: Double-blind short-term trial of furazolidone in peptic ulcer. Lancet 1985;i:1048–1049.
33.
Altamirano A, Bondani A: Adverse reactions to furazolidone and other drugs: A comparative review. Scand J Gastroenterol Suppl 1989;169:70–80.
[PubMed]
34.
Segura AM, Gutierrez O, Otero W, et al: Furazolidone, amoxicillin, bismuth triple therapy for Helicobacter pylori infection. Aliment Pharmacol Ther 1997;11:529–532.
[PubMed]
35.
Xiao SD, Liu WZ, Hu PJ, et al: A multicenter study on eradication of Helicobacter pylori using four 1-week triple therapies in China. Aliment Pharmacol Ther 2001;15:81–86.
[PubMed]
36.
Lerang F, Moum B, Ragnhildstveit E, et al: A comparison between omeprazole-based triple therapy and bismuth-based triple therapy for the treatment of Helicobacter pylori infection: A prospective randomized 1-year follow-up study. Am J Gastroenterol 1997;92:653–658.
[PubMed]
37.
Marshall BJ, Valenzuela JE, McCallum RW, et al: Bismuth subsalicylate suppression of Helicobacter pylori in nonulcer dyspepsia: A double-blind placebo-controlled trial. Dig Dis Sci 1993;38:1674–1680.
[PubMed]
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