Comparison of a triple therapy regimen containing ciprofloxacin and low dose furazolidone with conventional quadruple regimen for Helicobacter Pylori eradication

Helicobacter pylori treatment failure is becoming an important concern due to emergence of resistant strain. A major reason for the failure of anti-H pylori regimens in Iran is resistance to metronidazole. Studies have been shown that H pylori has lower resistant rate to ciprofloxacin and furazolidone. The aim of this open-label, randomized study was to compare the effectiveness and side effects of triple regimen containing furazolidone and ciprofloxacin with quadruple regimen containing metronidazole. Subjects and Cases were selected from patients who referred to gastroenterology clinic for evaluation of dyspepsia or other upper abdominal symptoms or signs. They included in the study if H pylori infection was confirmed by rapid urease test, or histological examination. Patients randomized into two groups (n=80 in each group) received 10 days therapy with: Regimen A: furazolidone 100 mg bid, ciprofloxacin 500 mg bid, and omeprazole 20 mg bid (FCO group). Regimen B: metronidazole 500 mg bid, tetracycline 500 mg bid, bismuth subcitrate 240 mg bid, omeprazole 20 mg bid, (MTBO group). The patients were observed for drugs complications during treatment period. Another 13C-urea breath test was performed 60 days after therapy. One hundred and sixty patients (83 females and 77 males), mean age 39.5 (range 15–78) years were included. Three patients in MTBO group and two patients in FCO group failed to complete the treatment because of side effects of drugs. The intention-to-treat eradication rates were 72.5% for CFO group and 80% for TMBO- group (P>0.05). Side effects were seen in 18.8% of CFO-group patients and 20% of TMBO-group patients (P>0.05). Nausea and vomiting were common side effects in group A and vertigo and bad taste sensation were the major side effects in the Group B. Triple regimen containing ciprofloxacin and low dose furazolidone, is a low-cost and safe alternative second or third-line therapy for H pylori eradication.