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Comparing Two Treatment Regimens for Helicobacter pylori Eradication: Furazolidone or Clarithromycin?
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Shirin Rezaei1    , Abdollah Pooshani2 , Sima Besharat3 , Mehrangiz Pichak4 , Alireza Norouzi *5 |
1- Internal Medicine, Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.
2- Gastroenterology and Liver Specialist, Clinical Research Development Unit (CRDU), Golestan University of Medical Sciences, Gorgan, Iran.
3- Associate Professor of Biomedical Sciences (By Research), Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.
4- General Physician, Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.
5- Associate Professor of Gastroenterology and Hepatology, Clinical Research Development Unit (CRDU), Golestan University of Medical Sciences, Gorgan, Iran. University of Queensland Faculty of Medicine, and Princess Alexandra Hospital Department of Gastroenterology and Hepatology Brisbane Queensland Australia. , norouzi54@gmail.com |
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Keywords: Helicobacter pylori [MeSH], Clarithromycin [MeSH], Furazolidone [MeSH], Peptic Ulcer [MeSH], Dyspepsia [MeSH]
Article ID: Vol27-15 |
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Type of Study: Original Articles |
Subject:
Gastroenterology
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Abstract: (7 Views) |
Extended Abstract
Introduction
Helicobacter pylori (H. pylori) is an exceptionally common cause of chronic bacterial infections in humans, with an estimated half of the global population being carriers. This gram-negative, flagellated bacillus remarkably colonizes the gastric mucosa, naturally adapting to the stomach's acidic environment. This colonization can persist throughout an individual's life and is recognized as a primary driver of various gastric pathologies. The consequences of H. pylori infection encompass chronic gastritis, peptic and duodenal ulcers, gastric cancer, and mucosa-associated lymphoid tissue (MALT) lymphoma. Evidence indicates that H. pylori eradication can culminate in the improvement of dyspepsia and peptic ulcers, while also preventing their progression to malignant diseases. Therefore, eradicating this bacterium is a significant therapeutic goal worldwide. Various treatment regimens are recommended based on factors, such as drug type, cost, availability, side effects, ease of use, patient condition, and drug resistance. The H. pylori recurrent infection rate varies among countries due to differences in socioeconomic factors and hygiene levels. Numerous domestic studies have evaluated the effectiveness of various treatment options for H. pylori eradication; however, the results have been inconsistent. Clarithromycin-based regimens are predominantly used for H. pylori eradication in Iran. Nevertheless, the most significant challenge in combating H. pylori infection is the increased antibiotic resistance, which has intensified across different regions of Iran over the past two decades. Recent evidence suggests that the mentioned treatment regimens yield recovery rates of less than 80%. A primary factor contributing to this statistic is the increased clarithromycin resistance. In Iran, the estimated resistance rates for metronidazole, clarithromycin, and amoxicillin are 64.9%, 25.3%, and 20.7%, respectively. Consequently, various studies are exploring effective alternatives to conventional treatment regimens.
Furazolidone, a nitrofuran derivative, exhibits both bacteriostatic and bactericidal effects against a wide range of gram-positive and gram-negative bacteria, and is well-absorbed in the intestine with no significant tissue accumulation. Research suggests that furazolidone-based quadruple treatment could be a promising alternative for effectively eradicating H. pylori infections, especially in regions with high rates of metronidazole and clarithromycin resistance.
While various treatment regimens for H. pylori eradication have been proposed in recent years, none have yet achieved universal endorsement. This study was conducted to compare the two treatment regimens, i.e., furazolidone and clarithromycin, for their effectiveness in H. pylori eradication.
Methods
This descriptive-analytical retrospective study was conducted on the medical records of 100 symptomatic patients (54 females and 46 males; mean age = 45.86 ± 11.97 years) confirmed with H. pylori infection, who presented to Shahid Sayyad Shirazi Educational-Therapeutic Center in Gorgan, northern Iran, for endoscopy during 2019.
Before performing endoscopy, informed consent was obtained from all patients. H. pylori infection was confirmed using either a urea breath test (UBT) or rapid urease test (RUT). Patient information, based on the required variables, was extracted from their medical records.
The inclusion criteria for the study were individuals at least 18 years of age exhibiting symptoms of H. pylori infection (such as indigestion, heartburn, nausea, and bloating), along with a diagnosis of dyspepsia or gastric ulcers. The exclusion criteria comprised patients with evidence of malignancy on endoscopic examination, individuals with underlying conditions (including congestive heart failure, renal failure, favism, liver cirrhosis, active gastrointestinal bleeding, pregnancy, and lactation). In addition, patients who did not complete the two-week treatment course were excluded from the study.
Patients under treatment received one of two routine oral quadruple drug regimens based on furazolidone and clarithromycin, as follows:
Group 1: Oral quadruple drug regimen consisting of bismuth subnitrate 240 mg twice daily, clarithromycin 500 mg twice daily, omeprazole 20 mg once daily, and amoxicillin 1000 mg twice daily for two weeks.
Group 2: Oral quadruple drug regimen consisting of bismuth subnitrate 240 mg twice daily, furazolidone 200 mg twice daily, omeprazole 20 mg once daily, and amoxicillin 1000 mg twice daily for two weeks.
Proper drug regimen adherence was assessed by pill counts and the number of empty medication boxes after two weeks of treatment. The H. pylori eradication rate was determined using a stool antigen test in individuals who completed the entire treatment course (four weeks after the end of the treatment regimen). Stool samples were collected at two time points: Initially at baseline and again after the completion of the treatment course.
Results
The H. pylori eradication rates were determined to be 98% for the furazolidone-based quadruple drug regimen and 94% for the clarithromycin-based quadruple drug regimen, with no statistically significant difference between them.
Furthermore, the odds ratio for H. pylori eradication was not statistically significantly associated with age, gender, or the type of treatment regimen.
Conclusion
Based on the results of the current study, the H. pylori eradication rate was determined to be similar for both treatment regimens, exceeding 90%.
The lower resistance to furazolidone can be considered one of the primary reasons for its higher success rate compared to clarithromycin.
Given the complications associated with furazolidone, such as headache, nausea, vomiting, and diarrhea, the occurrence of these complications can significantly impact patient adherence to treatment regimens. One reason for the lack of preference for furazolidone in clinical use is its gastrointestinal complications. Another factor that may justify the use of furazolidone in this context is its cost-effectiveness compared to clarithromycin.
One limitation of the current study is the lack of sufficient information regarding H. pylori strain resistance in Golestan Province. Additionally, the diverse ethnic composition of Golestan Province, compared to other regions of Iran, may influence the outcomes of different treatment regimens. On the other hand, drug side effects during the treatment process were completely and accurately recorded.
Ethical Statement
The study received approval from the Research Ethics Committee at Golestan University of Medical Sciences (IR.GOUMS.REC.1398.178). All participating patients provided written informed consent.
Funding
This article has been extracted from the doctoral dissertation of Dr. Shirin Rezaei in Internal Medicine residency at the Faculty of Medicine, Golestan University of Medical Sciences. This study received no institutional funding.
Authors' Contributions
Shirin Rezaei: Project administration and design, project execution, data collection, interpretation of the results, drafting of the initial manuscript, and approval of the final manuscript.
Abdollah Pooshani: Project administration and design, data collection, interpretation of the results, drafting of the initial manuscript, and approval of the final manuscript.
Sima Besharat: Data analysis, interpretation of the results, drafting of the initial manuscript, and approving the final manuscript.
Mehrangiz Pichak: Project execution, data collection, drafting of the initial manuscript, and approval of the final manuscript.
Alireza Norouzi: Project administration and design, project execution, data collection, data analysis, interpretation of the results, drafting of the initial manuscript, and approval of the final manuscript.
Conflicts of Interest
No conflicts of interest.
Acknowledgments
We would like to thank the Vice-Chancellor for Research and Technology, Golestan University of Medical Sciences, for their financial and executive support throughout this study. We also appreciate all staff members of the Endoscopy Ward at Shahid Sayyad Shirazi Educational-Therapeutic Center in Gorgan for their invaluable assistance.
Key Message: Both the furazolidone-based and clarithromycin-based two-week quadruple treatment regimens were effective in eradicating H. pylori, demonstrating no superiority over each other.
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Rezaei S, Pooshani A, Besharat S, Pichak M, Norouzi A. Comparing Two Treatment Regimens for Helicobacter pylori Eradication: Furazolidone or Clarithromycin?. J Gorgan Univ Med Sci 2025; 27 (2) :42-49 URL: http://goums.ac.ir/journal/article-1-4544-en.html
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