title: Comparison of quadruple and triple Furazolidone containing regimens on eradication of helicobacter pylori.
abstract: BACKGROUND
  The effectiveness of classic standard triple therapy regimen of helicobacter pylori (H. pylori) eradication has decreased to unacceptably low levels, largely related to development of resistance to metronidazole and clarithromycin. Thus successful eradication of H. pylori infections remains challenging. Therefore alternative treatments with superior effectiveness and safety should be designed and appropriately tested in all areas depending on the native resistance patterns. Furazolidone has been used successfully in eradication regimens previously and regimens containing furazolidone may be an ideal regimen.
  
  
  METHODS
  H. pylori infected patients with proven gastric or duodenal ulcers and /or gastric or duodenal erosions at Imam Khomeini Hospital in Sari/Northern Iran, were randomly allocated into three groups: group A (OABF) with furazolidone (F) (200 mg bid.), group B (OABM-F) metronidazole (M) (500 mg bid.) for the first five days, followed by furazolidone (F) (200 mg bid.) for the second five days and group C (OAF) with furazolidone (F) (200 mg tid.). Omeprazole (O) (20 mg bid.) and amoxicillin (A) (1000 mg bid.) were given in all groups; bismuth (B) (240 mg bid.) was prescribed in groups A & B. Duration of all eradication regimens were ten days. Eight weeks after treatment, a 14C-urea breath test was performed for evaluation of H. pylori eradication.
  
  
  RESULTS
  A total of 372 patients were enrolled in three groups randomly (124 patients in each group); 120 (97%) patients in group A (OABF), 120 (97%) in group B (OABM-F) and 116 (93%) in group C (OAF) completed the study. The intention-to-treat eradication rates were 83.7% (95% CI= 77.3-90.4), 79.8% (95% CI= 72.6-87), and 84.6% (95% CI= 78.2-91.1) and per-protocol eradication rates were 86.6% (95% CI= 80.5-92.8), 82.5% (95% CI= 75.6-89.4), and 90.5% (95% CI= 85.1-95.9) for groups OABF, OABM-F, and OAF, respectively. No statistical significant differences were found in case of severe drug adverse effects between the above mentioned three groups (p> 0.05). The most common side effects, namely nausea and fever, occurred in all groups, but more frequently in group C (OAF) (p< 0.05).
  
  
  CONCLUSIONS
  In developing countries such as Iran, furazolidone-based regimens can substitute clarithromycinbased regimens for H. pylori eradication because of a very low level of resistance, low cost and high effectiveness. Considering per-protocol eradication rate of ten days OAF regimen, and the acceptable limit of ninety percent, we recommend this regimen in developing countries such as Iran to be substituted of classic standard triple therapy. In order to minimize rare serious adverse effects, one week high dose OAF regimen should be taken into consideration in other studies.
authors.affiliation: Assistant Professor, Colorectal Research Center, Iran university of Medical Sciences, Rasool-e-Akram Hospital, Tehran, Iran. mokhtare.m@iums.ac.ir.
authors.forename: Marjan
authors.initials: M
authors.lastname: Mokhtare
authors.affiliation: Assistant Professor, Gut and Liver Research Center, Mazandaran University of Medical Sciences, Imam Khomeini Hospital, Sari, Iran. dr.vahid47@gmail.com , dr.vahid47@gmail.com.
authors.forename: Vahid
authors.initials: V
authors.lastname: Hosseini
authors.affiliation: Professor, Gut and Liver Research Center, Mazandaran University of Medical Sciences, Imam Khomeini Hospital, Sari, Iran. fakher42@yahoo.com.
authors.forename: Hafez
authors.initials: H
authors.lastname: Tirgar Fakheri
authors.affiliation: Associate Professor, Gut and Liver Research Center, Mazandaran University of Medical Sciences, Imam Khomeini Hospital, Sari, Iran. iradj2001@yahoo.com.
authors.forename: Iradj
authors.initials: I
authors.lastname: Maleki
authors.affiliation: Assistant professor, Gut and Liver Research Center, Mazandaran University of Medical Sciences, Imam Khomeini Hospital, Sari, Iran. tarang_taghvaei@yahoo.com.
authors.forename: Tarang
authors.initials: T
authors.lastname: Taghvaei
authors.affiliation: Assistant Professor, Gut and Liver Research Center, Mazandaran University of Medical Sciences, Imam Khomeini Hospital, Sari, Iran. seyedmohammadv@yahoo.com.
authors.forename: Seyed Mohammad
authors.initials: SM
authors.lastname: Valizadeh
authors.affiliation: Assistant Professor, Guilan University of Medical Sciences, International Branch, Bandar Anzali,Guilan, Iran. hsardarian@yahoo.com.
authors.forename: Hossein
authors.initials: H
authors.lastname: Sardarian
authors.affiliation: Associate Professor, Colorectal Research Center, Iran university of Medical Sciences, Rasool-e-Akram Hospital, Tehran, Iran. crrc.iums@gmail.com.
authors.forename: Shahram
authors.initials: S
authors.lastname: Agah
authors.affiliation: Professor PhD, Department of Biostatistics and Community Medicine, Imam Khomeini Hospital, Sari, Iran. khalilianir@yahoo.com.
authors.forename: Alireza
authors.initials: A
authors.lastname: Khalilian
keywords: Bismuth; Furazolidone; Helicobacter pylori; Treatment effectiveness