title: The efficacy of furazolidone-based quadruple therapy for eradication of Helicobacter pylori infection in Iranian patients resistant to metronidazole-based quadruple therapy.
abstract: BACKGROUND
  Furazolidone has recently shown promising efficacy in H. pylori eradication and has replaced metronidazole in different eradication regimens especially in countries, like Iran, with high prevalence of metronidazole resistance and where clarithromycin is expensive and hardly available. This study tries to determine the efficacy of a quadruple therapy based on furazolidone as a second line treatment.
  
  
  METHODS
  90 consecutive patients with a prior history of H. pylori infection who had failed to respond to a 14 day course of metronidazole-based quadruple therapy were included to take a two week quadruple therapy consisting of furazolidone, bismuth subcitrate, amoxicillin and omeprazole. Eradication was described as negative 14C-urea breath test, 4 to 6 weeks after end of the treatment.
  
  
  RESULTS
  89 of 90 patients completed the treatment course. The total eradication rate was 70/89 (78.7%). 35/49 (71.4%) of male patients and 35/40 (87.5%) of female patients had successful eradication. Eradication rate did not have any significant relationship with patient's sex (p>0.05). All patients had at least one upper GI endoscopy before the treatment by which they were categorised into three groups: duodenal ulcer (DU, 78.9%), gastric ulcer(GU, 11.1%) and non-ulcer dyspepsia (NUD, 10%). Eradication rates was different in these groups, but not significantly (p>0.05). Eradication rate was significantly lower in smokers (p<0.05, OR=3.12).
  
  
  CONCLUSIONS
  Furazolidone can replace metronidazole successfully in those patients who have failed to respond to metronidazole-based quadruple therapy and it is well tolerated. We recommend it, especially in countries where clarithromycin is expensive or not available.
authors.affiliation: Digestive Disease Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Naser
authors.initials: N
authors.lastname: Ebrahimi-Dariani
authors.forename: Shahram
authors.initials: S
authors.lastname: Mirmomen
authors.forename: Fariborz
authors.initials: F
authors.lastname: Mansour-Ghanaei
authors.forename: Pedram
authors.initials: P
authors.lastname: Noormohammadpoor
authors.forename: Rasoul
authors.initials: R
authors.lastname: Sotodehmanesh
authors.forename: Bahram
authors.initials: B
authors.lastname: Haghpanah
authors.forename: Hossein
authors.initials: H
authors.lastname: Bahrami
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D001944:Breath Tests; D024881:Drug Resistance, Bacterial / Q000502:physiology*; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D005664:Furazolidone / Q000627:therapeutic use*; D016481:Helicobacter Infections / Q000188:drug therapy*; D006801:Humans; D007492:Iran; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D008795:Metronidazole; D005664:Furazolidone