Tehran University Medical Journal

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Background: Resistance to metronidazole is one of the most common reasons for Helicobacter pylori treatment failure with classic triple therapy. The clarithromycin–based regimen is not cost – effective for developing countries and also there is a lot of evidence about increase of clarithromycin resistance H-pylori. Furazolidone is a good substitute, but several side effects, limit its widespread use our previous revealed that most of side effects occurred in the beginning of second week of treatment, so decrease the period of furazolidone therapy to one week may be considered. The aim of the present study was to assess the efficacy and side effect of one week furazolidone in combination with bismuth subcitrate ,amoxycillin and omprazole
Methods: In this study, a total of 177 patients were enrolled and randomized to two groups and received the following medications: Group I: omprazole 220mg + amoxycillin 21gr + bismuth subcitrate 4120 mg for two weeks and furazolidone 2200mg for 1 week Group II: the same regimen as in group I except that one week furazolidone in group II patients followed by one week metronidazole 2500 mg/day (one week furazolidone and one week metronidazole).patients were followed after 2 weeks for side effect of drugs and compliance and control endoscopy was performed after 6 weeks and three biopsies spicimens from the antrum and three from the corpus were taken for a urease test and histology. Eradication was concluded if all the tests were negative for H-pylori Results: One hundred fifty seven patients completed the study. Mean age was 38.84+10.42 and 55.4% were male and 44.6% were female. Two patients from group I and three patients from group II did not tolerate the regimen and were excluded from the study. No serious complication was detected in two groups. The eradication rate per protocol analysis and intention to treat analysis were 89% and 79.3% in group 1 and 86.6% and 74.4% in group 2.No significant statistical differents between two groups (P=0.32 , P=0.33).
Conclusion: One week furazolidone in combination with two weeks amoxicillin, omprazole and bismuth subcitrate is a good, safe and cost effective regimen for eradication of H-pylori. Addition of metronidazole in the second week of treatment period did not increase eradication rate.