Furazolidone versus ampicillin in the treatment of traveler's diarrhea

Self Cite

Section: Resultssupporting

confidence: 80%

mentioning

confidence: 99%

Five versus three days of ofloxacin therapy for traveler's diarrhea: a placebo-controlled study

DuPont

Ericsson

Mathewson

et al. 1992

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“…Although the eradication of viable vibrios occurred almost identically fast in the two groups, the group of patients receiving furazolidone for 3 days showed somewhat earlier cessation of diarrhea, lower stool volume, and higher rate of stopping diarrhea by 72 h after start of treatment than the patients treated once with a single dose. This slight advantage of the 3-day regimen for the clinical course of diarrhea could be the result of an earlier or more complete cessation of cholera toxin production by bacteria after exposure to furazolidone or of therapeutic effects of furazolidone in the larger dose on other intestinal bacteria, including Campylobacter spp., or the intestinal protozoan Giardia lamblia (2,9,10,21), which in some patients may have been copathogens.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of a single dose of furazolidone for treatment of cholera in children

Rabbani

Butler

Shahrier

et al. 1991

To test the efficacy and safety of furazolidone given as a single dose for childhood cholera, a randomized double-blind placebo-controlled trial was carried out among 118 culture-positive dehydrated children with diarrhea. Patients were randomly assigned to one of four groups to receive medication orally in liquid suspension: furazolidone at 7 mg/kg/day once, furazolidone at 7 mg/kg/day divided into four doses for 3 days, placebo once, or placebo for 3 days. After 12 patients with furazolidone-resistant infections were excluded from the analysis of efficacy, it was determined that both groups treated with furazolidone showed significantly higher rates of bacteriologic success (stool cultures negative for Vibrio cholerae on days 2 to 4 after start of therapy) and clinical success (cessation of diarrhea within 72 h after start of therapy) than corresponding placebo groups (P < 0.001). There were no significant differences between responses to the 3-day and single-dose regimens of furazolidone, but there was a trend toward better clinical responses in patients who received furazolidone for 3 days. No patient treated with furazolidone dropped out because of side effects. These results indicate that furazolidone, given as either a single dose or divided doses for 3 days, is effective treatment for childhood cholera.Cholera is an acute illness caused by an enterotoxin produced by Vibrio cholerae that have colonized in the small bowel. In its most severe form, there is rapid loss of fluid and electrolytes from the gastrointestinal tract, resulting in hypovolemic shock, metabolic acidosis, and, if untreated, death (20). Cholera remains one of the diarrheal diseases with significant mortality in many developing countries (4). Fluid replacement is the most important component of therapy. While antibiotics are not essential to the treatment of the disease, they do shorten the duration of excretion of vibrios, the duration and volume of diarrhea, and the amount of fluid replacement required (5). Tetracycline is the antibiotic of choice for the treatment of cholera, and consideration of alternative drugs has been confined to the treatment of pregnant women and children for whom tetracycline was contraindicated because it stains developing teeth (8). Additionally, in areas such as Bangladesh, where multiply antibiotic-resistant V. cholerae have emerged, an alternative treatment must be considered (11).Furazolidone is effective in the treatment of cholera when given in multiple doses or single daily doses for 3 to 7 days (7,8,14,17 Treatment and clinical observations. After selection for the study, patients were allocated to one of four treatment groups according to a computer-generated list of random numbers. The treatments consisted of liquid suspensions of (i) furazolidone (7 mg/kg/day) given as a single dose on day 1, (ii) placebo liquid suspension given as a single dose on day 1, (iii) furazolidone (7 mg/kg/day) given in four equal daily doses on days 1, 2, and 3, and (iv) placebo liquid suspension given in four equal dai...

“…Furazolidone has broad-spectrum activity against bacteria and Giardia lamblia, and its major clinical use in humans has been in the therapy of bacterial diarrhea and giardiasis (6,9,19,23,26,33). The drug has also exhibited activity in vitro or in animal models against leishmanias, trichomonads, trypanosomes, and filariae, but clinical trials have been disappointing (1, 3-5, 14, 16, 18, 22, 24, 38).…”

Section: Discussionmentioning

confidence: 99%

Furazolidone and nitrofurantoin in the treatment of experimental Pneumocystis carinii pneumonia

Walzer

Kim

Foy

et al. 1991

Furazolidone and nitrofurantoin, oral nitrofuran derivatives with broad-spectrum antimicrobial properties already in clinical use, were compared for activity against Pneumocystis carinii in an immunosuppressed rat model of P. carinii pneumonia. Furazolidone exhibited only slight activity as a prophylactic agent but was moderately effective in the therapy of pneumocystosis. The median histologic score and organism count fell from 4+ and and their toxic effects on the rats will probably discourage investigation of this drug in the treatment of pneumocystosis in humans. Nevertheless, since many nitrofurans have been synthesized, further exploration of this class of compounds might be helpful in developing new anti-P. carinii agents or in studying structureactivity relationships.Pneumocystis carinii is a leading cause of pneumonia in immunosuppressed patients. The incidence of pneumocystosis has increased markedly over the past decade in association with the emergence of AIDS (34). Treatment of P. carinii pneumonia in AIDS patients has been hindered by a high frequency of recurrence and of toxic reactions to antimicrobial drugs. Anti-P. carinii compounds currently in clinical use include inhibitors of dihydrofolate reductase (e.g., trimethoprim [TMP], trimetrexate), sulfonamides (sulfamethoxazole [SMX]), and sulfones (dapsone); diamidines (pentamidine isethionate); polyamine inhibitors (adifluromethylornithine); and the combination of clindamycin and primaquine (2,11,13,21,27).Our laboratory has been engaged in developing new forms of P. carinii therapy for the past several years (8,15,35,36). Drug selection has been hampered by the lack of knowledge about the metabolic pathways of the organism. Studies are conducted in an animal model in which rats given corticosteroids spontaneously develop pneumocystosis by a process of reactivation of latent infection. Although this system permits evaluation of relatively few compounds, it has been a reliable predictor of drug activity in humans (10, 12).Here we report our experience with two nitrofuran derivatives, furazolidone and nitrofurantoin. Nitrofurans possess broad antimicrobial properties, including activity against trypanosomes (4,20,25,26,29,31). Our rationale for testing them against P. carinii was based on the following considerations. First, several classes of drugs (e.g., diamidines, polyamine inhibitors, purine nucleosides) with antitrypanosomal properties have been shown to be effective against P. carinii, although the specific mechanisms of action are unknown (8,21,28,36). Second, since furazolidone and nitrofurantoin are oral preparations and are already in clinical use, they would be much easier to develop as anti-P. carinii drugs than would unlicensed compounds with poorly * Corresponding author. understood pharmacokinetic properties or toxicological profiles. MATERIALS AND METHODSExperimental design. (i) Treatment. The animal protocol that we used has been described in detail previously (15,(35)(36)(37). In brief, adult male Sprague-Dawley rats (Harlan I...