Short-duration furazolidone therapy in combination with amoxicillin, bismuth subcitrate, and omeprazole for eradication of Helicobacter pylori

Saudi J Gastroenterol. Jan-Mar 2010;16(1):14-8. doi: 10.4103/1319-3767.58762.

Abstract

Background/aim: Resistance to metronidazole is one of the most common reasons for Helicobacter pylori treatment failure with the classic triple therapy. The clarithromycin-based regimen is not cost-effective for use in developing countries. Though furazolidone is a great substitute it has many side effects. Decreasing the duration of treatment with furazolidone to 1 week may help decrease the drug's side effects.

Aim: To study the efficacy and side effects of furazolidone when given for 1 week in combination with bismuth subcitrate, amoxicillin, and omeprazole.

Materials and methods: One hundred and seventy-seven patients with duodenal ulcer were randomly divided into two groups. Group I received omeprazole 2 Chi 20 mg + amoxicillin 2 Chi 1 g + bismuth subcitrate 4 Chi 120 mg for 2 weeks, with furazolidone 2 Chi 200 mg in the first week only. Group II received the same regimen, except that 1 week of furazolidone was followed by 1 week of metronidazole in the second week. Control endoscopy was performed after 6 weeks. Three biopsies from the antrum and three from the corpus were taken for urease testing and histology. Eradication was concluded if all tests were negative for H pylori.

Results: One hundred and fifty-seven patients completed the study. Two subjects from group I and three from group II did not tolerate the regimen and were excluded from the analysis. No serious complication was detected in any patient. The eradication rates by per-protocol (PP) analysis and intention-to-treat (ITT) analysis were 89% and 79.3% in group I and 86.6% and 74.4% in group II, respectively.

Conclusion: One week of furazolidone in combination with 2 weeks of amoxicillin, omeprazole, and bismuth subcitrate is a safe and cost-effective regimen for the eradication of H pylori. Adding metronidazole to the above regimen does not increase the eradication rate.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Amoxicillin / administration & dosage
  • Anti-Bacterial Agents / administration & dosage*
  • Anti-Ulcer Agents / administration & dosage*
  • Drug Therapy, Combination
  • Duodenal Ulcer / drug therapy*
  • Duodenal Ulcer / microbiology
  • Female
  • Furazolidone / administration & dosage
  • Helicobacter Infections / drug therapy*
  • Humans
  • Male
  • Middle Aged
  • Omeprazole / administration & dosage
  • Organometallic Compounds / administration & dosage
  • Time Factors
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Anti-Ulcer Agents
  • Organometallic Compounds
  • Furazolidone
  • Amoxicillin
  • bismuth tripotassium dicitrate
  • Omeprazole