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Furazolidone, an Underutilized Drug for H. pylori Eradication: Lessons from Iran

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Abstract

Background

Treatment success of H. pylori eradication therapy has declined worldwide largely because of increased antimicrobial resistance. New therapeutic approaches are needed, especially for countries like Iran, where resistance to commonly used drugs is already widespread and traditional H. pylori therapies produce poor cure rates.

Aim

To review the results of quadruple therapy trials containing bismuth and furazolidone in Iran.

Methods

We searched PubMed, Google scholar as well as the references of all published papers for studies conducted in Iran, utilizing furazolidone in the treatment of H. pylori infections. The target population was four drug studies that utilized a combination of bismuth, furazolidone, amoxicillin, or tetracycline plus a proton pump inhibitor.

Results

Eighteen studies with 22 arms including 1713 subjects were found. The weighted mean cure rate for 14-day studies (six studies) using 200 mg b.i.d. furazolidone was 80% intention to treat (ITT) and 87% per protocol (PP). Studies using 100 mg b.i.d. (three studies) were less effective (weighted mean ITT cure rate = 67%). One small 14-day study with furazolidone 100 mg q.i.d. achieved cure rates of 94.5% ITT and PP.

Conclusions

Although furazolidone–bismuth quadruple therapy proved relatively effective in Iran, furazolidone-containing regimens remain to be optimized. Based on these data and results from China, it appears likely that 14-day therapy containing furazolidone 100 mg t.i.d. or q.i.d. is likely to provide the highest cure rates with lowest side effects; this remains to be experimentally tested. Detailed suggestions for further development of furazolidone-containing regimens are provided.

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Acknowledgments

The authors thank Dr. Farideh Siavoshi, Ph.D., for her many helpful comments and references. Dr. Graham was supported in part by the Office of Research and Development Medical Research Service Department of Veterans Affairs, Public Health Service Grant DK56338 which funds the Texas Medical Center Digestive Diseases Center. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the VA or NIH. Dr. Mohammadi was supported by research grants from Pasteur Institute of Iran.

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Author notes

  1. Marjan Mohammadi, Bahareh Attaran, Reza Malekzadeh and David Y. Graham have contributed equally to the manuscript.

Authors and Affiliations

  1. HPGC Research Group, Department of Medical Biotechnology, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran

    Marjan Mohammadi & Bahareh Attaran

  2. Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran

    Reza Malekzadeh

  3. Department of Medicine, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, RM 3A-318B (111D), 2002 Holcombe Boulevard, Houston, TX, 77030, USA

    David Y. Graham

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  1. Marjan Mohammadi
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Correspondence to David Y. Graham.

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Conflict of interest

Dr. Graham is a paid consultant for RedHill Biopharma regarding novel H. pylori therapies and for BioGaia regarding use of probiotics for H. pylori infections. None of other authors report conflicts.

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Mohammadi, M., Attaran, B., Malekzadeh, R. et al. Furazolidone, an Underutilized Drug for H. pylori Eradication: Lessons from Iran. Dig Dis Sci 62, 1890–1896 (2017). https://doi.org/10.1007/s10620-017-4628-5

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