Furazolidone, Co-amoxiclav, Colloidal Bismuth Subcitrate, and Esomeprazole for Patients Who Failed to Eradicate Helicobacter pylori with Triple Therapy

Abstract

There is increasing evidence of Helicobacter pylori (H. pylori) resistance to the classical triple therapy consisting of a proton-pump inhibitor and clarithromycin with either amoxicillin or metronidazole. This study is aimed at establishing the efficacy and safety of a 14-day regimen to eradicate H. pylori in patients who have failed with the classical triple therapy given for 14 days. One hundred seventy-six patients diagnosed to have H. pylori infection were given triple therapy for 14 days. Fifty-two patients who failed to respond as evident from positive 14C-urea breath test (UBT) done 4-6 weeks after the completion of triple therapy were offered a combination regimen comprised of furazolidone 200 mg b.i.d, co-amoxiclav 1 g b.i.d., colloidal bismuth subcitrate 240 mg b.i.d., and esomeprazole 40 mg b.i.d. for 14 days. The mean age of these patients was 41 +/- 13 years (range 20-67). Thirty-four were males. To document eradication of H. pylori, UBT was repeated 4 weeks after the completion of treatment. On an intention-to-treat analysis, the eradication rate was 81% (42 out of 52) whereas on per-protocol basis, the eradication rate was 82.4% (42 out of 51). In conclusion, this new regimen represents a suitable second-line therapy.

Furazolidone-based therapies for Helicobacter pylori infection: A pooled-data analysis

“…There were 4 studies from Brazil,[46–49] 2 from Iran,[5051] 3 from China,[52–54] 2 from Russia,[5556] and 1 each from Ireland,[57] Germany,[6] Mexico,[58] and Pakistan,[59] reporting data of furazolidone-based rescue therapies. In detail, 64 patients failed three consecutive therapies, 114 two treatments, and 622 patients the first-line therapy.…”

Effects of packaging and storage conditions on the quality of amoxicillin-clavulanic acid – an analysis of Cambodian samples

“…In combined preparations, 125 mg of clavulanic acid is sufficient to inhibit β-lactamase–producing organisms. Amoxicillin–clavulanic acid also has proven more effective for the eradication of H. pylori than conventional monotherapies [13,14]. However, insufficient doses and inappropriate use of such potent antibiotics may lead to the development of resistance [15].…”

Aqueous and Organic Solvent-Extracts of Selected South African Medicinal Plants Possess Antimicrobial Activity against Drug-Resistant Strains of Helicobacter pylori: Inhibitory and Bactericidal Potential

“…Current eradication regimens involve the use of combination therapies; a proton pump inhibitor (PPI) or bismuth compounds and two antibiotics, most commonly clarithromycin and metronidazole or amoxicillin [5], with an expected success rate of 80%–90% [6]. However, H. pylori infection is still difficult to treat as eradication failure rate remains at 10%–40% [7,8]. …”

“…With primary susceptibility patterns becoming less predictable, it is not uncommon to find other stronger antibiotics, particularly from the flouroquinolone group, being part of the treatment regimen [10], but H. pylori is developing resistance to these drugs too [11]. Other problems, including undesirable side effects (nausea, vomiting, diarrhea, stomach ache) and poor patient compliance are associated with significant levels of treatment failure and contraindications for some patients [8]. In addition, combination therapy is not readily affordable and some of the drugs are not available in some rural settings in the developing world.…”