Furazolidone combination therapies for Helicobacter pylori infection in the United States.
BACKGROUND
Antibiotic resistance has begun to impair the ability to cure Helicobacter pylori infection.


OBJECTIVE
To evaluate furazolidone as a component of combination therapies for treatment of H. pylori infection in the United States.


METHODS
Patients with active H. pylori infection received furazolidone combination therapy for 14 days (furazolidone 100 mg and tetracycline 500 mg t.d.s.; omeprazole 20 mg o.d. in the morning and, depending on the pre-treatment antimicrobial susceptibility pattern, 500 mg of metronidazole or clarithromycin t.d.s.).


RESULTS
A total of 27 patients received the metronidazole containing combination (cure rate 100%) and seven received the clarithromycin combination (cure rate 86%). Overall the cure rates for intention-to-treat was 97% (95% CI: 85% to 100%). The single failure took the clarithromycin containing combination for only 2 days (per protocol cure rate = 100%). Side-effects were common and led to discontinuation of therapy in 26% of patients. An attempt to eliminate metronidazole and clarithromycin and use furazolidone, tetracycline, and lansoprazole b.d. produced an unsatisfactory cure rate of 72%.


CONCLUSIONS
Furazolidone combination therapy appears to be effective. Additional studies with different antimicrobial combinations and duration of therapy are warranted.
Graham
D Y
DY
The VA Medical Center, Houston, Texas 77030, USA. dgraham@bcm.tmc.edu
Osato
M S
MS
Hoffman
J
J
Opekun
A R
AR
Anderson
S Y
SY
El-Zimaity
H M
HM
D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D017291:Clarithromycin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D004352:Drug Resistance, Microbial / Q000502:physiology; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D005664:Furazolidone / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D011446:Prospective Studies; D013752:Tetracycline / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D013997:Time Factors; D014481:United States
D000897:Anti-Ulcer Agents; D008795:Metronidazole; D005664:Furazolidone; D013752:Tetracycline; D017291:Clarithromycin; D009853:Omeprazole