Efficacy of a quadruple therapy regimen for Helicobacter pylori eradication after partial gastrectomy

We aimed to evaluate the effectiveness and safety of bismuth-containing quadruple therapy plus postural change after dosing for Helicobacter pylori eradication in gastrectomized patients. We compared 76 gastric stump patients with H. pylori infection (GS group) with 50 non-gastrectomized H. pylori-positive patients who met the treatment indication (controls). The GS group was divided into GS group 1 and GS group 2. All groups were administered bismuth potassium citrate (220 mg), esomeprazole (20 mg), amoxicillin (1.0 g), and furazolidone (100 mg) twice daily for 14 days. GS group 1 maintained a left lateral horizontal position for 30 min after dosing. H. pylori was detected using rapid urease testing and histologic examination of gastric mucosa before and 3 months after therapy. Mucosal histologic manifestations were evaluated using visual analog scales of the updated Sydney System. GS group 1 had a higher prevalence of eradication than the GS group 2 (intention-to-treat [ITT]: P=0.025; per-protocol [PP]: P=0.030), and the control group had a similar prevalence. GS group 2 had a lower prevalence of eradication than controls (ITT: P=0.006; PP: P=0.626). Scores for chronic inflammation and activity declined significantly (P<0.001) 3 months after treatment, whereas those for atrophy and intestinal metaplasia showed no significant change. Prevalence of adverse reactions was similar among groups during therapy (P=0.939). A bismuth-containing quadruple therapy regimen plus postural change after dosing appears to be a relatively safe, effective, economical, and practical method for H. pylori eradication in gastrectomized patients.

Evaluation of furazolidone, sulfadimidine and amprolium to treat coccidiosis in beetal goats under field conditions

Coccidiosis is a protozoal and occasionally fatal diarrheic disease of goats imposing heavy economic losses to farming community. This study aimed to evaluate the efficacies of Furazolidone, Sulfadimidine and Amprolium against coccidiosis in Beetal goats. Twenty-four [24] Beetal goats naturally infected with coccidiosis were randomly divided into four groups of 6 [A-D]. Goats in groups A, B and C were treated orally with Furazolidone [10mg/Kg], Sulfadimidine [100mg/Kg] and Amprolium [55mg/Kg], respectively for 7 days. Goats in-group D served as positive control. Oocysts per gram [OPG] of feces counts of individual goats in each group were performed on Days; 0 [pre-treatment] 7, 14 and 21 [post-treatment]. OPG counts amongst goats in all groups at day 0 were not significant [P>0.05]. On days 7, 14 and 21, OPG values decreased significantly [P<0.05] in groups A, B and C compared to group D. The efficacy of Furazolidone, Sulfadimidine and Amprolium was 98.6, 98.0 and 99.6 percent, respectively on Day 21 [end of trial]. Statistically, the efficacies of three drugs were not significantly different [P>0.05]. In conclusion, Furazolidone, Sulfadimidine and Amprolium are well-tolerated and any one of these may be recommended to effectively treat coccidiosis in Beetal goats

Helicobacter pylori não erradicado com o esquema tradicional: O que fazer? / Helicobacter pylori is not eradicated with traditional scheme: What to do?

O Helicobacter pylori é considerado a infecção mais prevalente no mundo. Sua prevalência é superior a 80% em países em desenvolvimento, com uma parcela de infectados desenvolvendo sintomas e doença, algumas delas com correlação etiopatogênica e resposta terapêutica bem definidas na literatura; outras apresentam estudos com resultados conflitantes, não havendo indicação de tratamento. Apesar de os esquemas de erradicação inicialmente apresentarem índices de sucesso superiores a 90%, falha terapêutica de até 50% tem sido relatada em algumas regiões, decorrente principalmente da resistência aos antibióticos. O desafio atual é identificar os esquemas terapêuticos mais efetivos.

Helicobacter pylori is considered the most prevalent infection worldwide, with its prevalence above 80% in developing countries, having a portion of the infected people developing symptoms and disease, some of them with etiopathogenic correlation and well defined therapeutic response in the literature and other present studies with conflicting results having no indication for treatment. Despite the scheme of eradication initially present successful index rates greater than 90%, therapeutic failure of up to 50% has been reported in some regions, arising mainly to antibiotic resistance. The current challenge is to identify the most effective scheme treatments.

Inhibition of shrimp pathogenic vibrios by extracellular compounds from a proteolytic bacterium Pseudomonas sp. W3 / Inhibición de vibrios patógenos del camarón por compuestos extracelulares de una bacterias proteolítica Pseudomonas sp.W3

Pseudomonas sp. W3, a bacterium known to produce an extracellular alkaline protease, secreted secondary metabolites that inhibited pathogenic bacteria responsible for shrimp luminous vibriosis disease. Antivibrio compounds in the culture supernatant or culture filtrates (0.45 um and 0.22 um) of the isolate W3 were tested using an agar well diffusion method on a number of pathogenic vibrios. Vibrio harveyi PSU 2015 a pathogenic isolate was the most sensitive strain. The effectiveness of preparations from the isolate W3 against V. harveyi PSU 2015, and V. cholerae PSSCMI 0062 was in the order of culture supernatant > 0.45 um culture filtrate > 0.22 um culture filtrate. These extracellular antivibrio compounds also lysed both dead and living cells of V. harveyi PSU 2015. Results of the partial characterization tests indicated that there was some particulate antivibrio compound that was destroyed by treatment with enzymes particularly alpha-chymotrypsin, autoclaving at 121ºC for 15 min and was mostly removed by filtration through a 0.22 µm filter. Most of the inhibitory compounds were of small molecular weight able to pass through a 0.22 um filter and were resistant to treatment with various enzymes, pH values between 4-8 and temperatures up to 121ºC for 30 min. The optimum pH for the antivibrio activity in the 0.45 um culture filtrate was between pH 6-7.

Furazolidona, tetraciclina e omeprazol: uma alternativa de baixo custo para erradicação de Helicobacter pylori em crianças / Furazolidone, tetracycline and omeprazole: a low-cost alternative for Helicobacter pylori eradication in children

OBJETIVOS: Avaliar furazolidona, tetraciclina e omeprazol como tratamento de primeira linha para Helicobacter pylori em crianças com sintomas digestivos. MÉTODOS: Ensaio clínico aberto, prospectivo e consecutivo. O estudo incluiu pacientes acima de 8 anos com dispepsia funcional, dor abdominal funcional, anormalidades histológicas graves (metaplasia intestinal, atrofia gástrica ou linfoma do tecido linfóide associado às mucosas) ou úlcera péptica. A presença de H. pylori foi definida com base em exame histológico e teste da urease. O regime medicamentoso consistiu de um tratamento de 7 dias com omeprazol, tetraciclina (ou doxiciclina) e furazolidona duas vezes por dia. A erradicação foi avaliada através de endoscopia digestiva alta 2 meses após o tratamento (exame histológico e teste da urease). Avaliações clínicas posteriores foram realizadas 7 dias e 2 meses após o tratamento. RESULTADOS: Foram incluídos 36 pacientes (21 meninas/15 meninos). A idade variou de 8 a 19 anos (média de 12,94+2,89 anos). Na análise por intenção de tratar (n = 36), a taxa de erradicação foi de 83,3 por cento (IC95 por cento 77,1-89,5), ao passo que na análise por protocolo (n = 29), foi de 89,7 por cento (IC95 por cento 84,6-94,7). A adesão foi melhor quando se utilizou doxiciclina, mas as taxas de sucesso foram semelhantes para as duas tetraciclinas. Não houve nenhuma variável associada à falha no tratamento. Foram relatados efeitos colaterais em 17 pacientes (47,2 por cento), principalmente dor abdominal (11/30,5 por cento), náusea (sete/19,4 por cento) e vômitos (cinco/13,9 por cento). CONCLUSÃO: A terapia tripla com furazolidona e tetraciclina é uma alternativa de baixo custo para o tratamento da infecção pelo H. pylori.

OBJECTIVE: To evaluate furazolidone, tetracycline and omeprazole as first line therapy for Helicobacter pylori in children with digestive symptoms. METHODS: Prospective and consecutive open trial. The study included patients older than 8 years old with functional dyspepsia, functional abdominal pain, severe histological abnormalities (intestinal metaplasia, gastric atrophy or mucosa-associated lymphoid tissue lymphoma) or peptic ulcer. H. pylori status was defined based both upon histology and rapid urease test. Drug regimen was a 7-day course of omeprazol, tetracycline (or doxycycline) and furazolidone twice daily. Eradication was assessed by upper endoscopy 2 months after treatment (histology and rapid urease test). Further clinical evaluation was done 7 days and 2 months after treatment. RESULTS: Thirty-six patients (21 female/15 male) were included. Age ranged from 8 to 19 years (mean 12.94+2.89 years). On intention-to-treat analysis (n = 36), eradication rate was 83.3 percent (95 percentCI 77.1-89.5) whereas in per-protocol analysis (n = 29), it was 89.7 percent (95 percentCI 84.6-94.7). Compliance was better when doxycycline was used, but the success rates were similar for the two tetracyclines. There was no variable associated with treatment failure. Side effects were reported in 17 patients (47.2 percent), mainly abdominal pain (11/30.5 percent), nausea (seven/19.4 percent) and vomiting (five/13.9 percent). CONCLUSION: Triple therapy with furazolidone and tetracycline is a low-cost alternative regimen to treat H. pylori infection.

A furazolidone-based quadruple therapy for Helicobacter pylori retreatment in patients with peptic ulcer disease

OBJETIVO: Muitos dos esquemas atualmente usados na erradicação do Helicobacter pylori não conseguem curar a infecção, pela resistência bacteriana ou pela baixa adesão do paciente. Esta condição manterá os riscos de desenvolvimento das potenciais complicações graves da infecção. Este estudo procurou determinar a eficácia e segurança de um esquema quádruplo que associou a furazolidona para o retratamento da infecção pelo H. pylori. MÉTODOS: Pacientes que não alcançaram erradicação em um ou mais tratamentos foram submetidos à endoscopia digestiva alta e dois fragmentos do antro e do corpo foram retirados para exame histológico e de urease. Receberam então 20mg de omeprazol, 240mg de sub-citrato de bismuto, 500mg de tetraciclina e 200mg de furazolidona duas vezes ao dia por 7 dias. O sucesso terapêutico foi determinado pela negativação de nova biópsia endoscópica, após 8 semanas do tratamento. RESULTADOS: Sessenta e dois pacientes foram incluídos, cinqüenta e oito completaram o estudo. Por protocolo, 67% (39/58) dos pacientes conseguiram a erradicação da bactéria. Efeitos adversos leves foram relatados. CONCLUSÃO: O tratamento de curto prazo, em esquema quádruplo com a furazolidona , é bem tolerado, barato e eficaz no re-tratamento do H. pylori. Uma boa opção de re-tratamento para países em desenvolvimento.

Helicobacter pylori eradication using tetracycline and furazolidone versus amoxicillin and azithromycin in lansoprazole based triple therapy: an open randomized clinical trial

RACIONAL: Ainda não está estabelecida a melhor terapêutica anti-H. pylori. OBJETIVO: Avaliar a erradicação de H.pylori usando tetraciclina e furazolidona versus amoxicilina e azitromicina em terapia tríplice com lansoprazol no nordeste do Brasil. PACIENTES E MÉTODOS: Cento e quatro pacientes infectados por H. pylori, diagnosticado através do teste rápido da urease e histologia, foram selecionados aleatoriamente para receber: lansoprazol (30 mg q.d.), tetraciclina (500 mg q.i.d.), furazolidona (200 mg t.i.d.) por 7 dias (LTF; n = 52); ou lansoprazol (30 mg b.i.d.) e amoxicilina (1 g b.i.d.) por 1 semana, mais azitromicina (500 mg q.d.) nos primeiros 3 dias (LAAz; n = 52). A erradicação de H.pylori foi avaliada 3 meses após término da terapia através do teste da urease, histologia e teste respiratório usando uréia marcada com 14Carbono. RESULTADOS: A erradicação do H. pylori foi atingida em 46 de 52 (88.4%, 95% CI: 77.5%-95.1%) pacientes no grupo LTF e em 14 de 52 (26.9%, 95% CI: 16.2%-40,1%) pacientes no grupo LAAz. Na análise per-protocolo, a taxa de erradicação foi de 91.8% (95% CI: 81.4%-97.3%) e 28.5% (95% CI: 17.2%-42.3%), respectivamente no grupo de LTF e LAAz. CONCLUSÃO: O esquema com LAAz ofereceu taxas de erradicação inaceitáveis. Por outro lado, o esquema com LTF representa alternativa adequada para erradicação de H.pylori.

Patrones de sensibilidad in vitro y comportamiento clínico de shigella / Susceptibility patterns and clinical presentation of shigella

Shigella mantiene un importante lugar como causa de diarrea en niños con aumento de su resistencia antimicrobiana en los últimos años, lo que dificulta la elección de terapia empírica en cuadros disentéricos. Se estudió la susceptibilidad antimicrobiana in vitro a 163 cepas aisladas entre 1997 y 1999. S. sonnei representó el 63 por ciento de las cepas aisladas. Se observó aumento en los patrones de resistencia de Shigella a los antimicrobianos tradicionales. La resistencia global de las cepas alcanzó a 95 por ciento para ampicilina, 84 por ciento para cloranfenicol, 43,6 por ciento para cotrimoxazol y 3,7 por ciento para furazolidona; no hubo resistencia a ciprofloxacina. De 57 niños hospitalizados por shigelosis, 82,5 por ciento tenían sobre 2 años de edad. Todos presentaron fiebre, 56 por ciento disentería y 8,8 por ciento convulsiones. Seis pacientes con evolución tórpida recibieron ciprofloxacina con éxito clínico. Ciprofloxacina representa una alternativa a evaluar como terapia empírica en niños con disentería de causa bacteriana. Es necesario mantener vigilancia local en la susceptibilidad antimicrobiana de Shigella a fin de guiar su terapia específica

Tratamiento de la úlcera péptica duodenal mediante erradicación del H. pylori: estudio controlado randomizado / Duodenal peptic ulcer treatment by H. pylori eradication: controled randomized study

La infección por Helicobacter pylori, representa un importante factor causal en el desarrollo de la úlcera péptica duodenal, en vista de lo cual se han desarrollado diversos esquemas terapéuticos encaminados a la eficaz erradicación del microorganismo. OBJETIVO: Evaluar en pacientes portadores de úlcera péptica duodenal, el efecto de un esquema acortado de doble terapia antibiótica asociado a famotidina, sobre la erradicación del Helicobacter pylori, así como sobre la cicatrización de la lesión ulcerosa y los cambios histológicos tras el tratamiento. MATERIAL y METODOS: Se incluyeron a 40 pacientes portadores de úlcera duodenal e infección por Helicobacter pylori, y se distribuyeron aleatoriamente en dos grupos, el grupo I recibió tetraciclina 2 gr./día más furazolidona 400 mg./día por una semana; y famotidina 40 mg./día por 4 semanas. El grupo II recibió sólo famotidina 40 mg./día por 6 semanas. En la endoscopía inicial se tomaron 4 biopsias del antro gástrico para estudio histológico y determinación de Helicobacter pylori. La endoscopía se repitió entre 6 a 8 semanas de iniciado el tratamiento antibiótico, momento en que de nuevo se tomaron 4 biopsias a nivel del antro gástrico con el mismo propósito, y se compararon los resultados. RESULTADOS: Veintiocho pacientes completaron el estudio, 14 del grupo I y 14 del grupo II. Se logró erradicar el Helicobacter pylori en el 85,7 por ciento de pacientes del grupo I, y en 0 por ciento del grupo II(p=0.00002). Se consiguió cicatrización de la úlcera en el 100 por ciento de pacientes del grupo I, en comparación al 85,7 por ciento del grupo II (p=0,48). El grado histológico de gastritis tras el tratamiento, mejoró significativamente en los pacientes del grupo I, en relación a los parámetros histológicos de severidad (p =0,002), actividad (p = 0.00002) y presencia de folículos linfoides (p =0.02). No se observó modificación significativa de los mismos parámetros en los pacientes del grupo II...

As Helicobacter pylori infection represents a very important causal factor in the development of duodenal peptic ulcer, several therapeutic trials have been developed in order to obtain an efficient eradication of the microorganismo. The aim of our study has been to evaluate, in patients with duodenal peptic ulcer, the effect of double antibiotic short therapy associated to famotidine on the eradication of Helicobacter pylori, cicatrizationof ulcerous lesion and the histological changes after the treatment.Forty patients with duodenal ulcer and Helicobacter pylori infection were distributed at random in two groups (I and II).Group I received tetracycline 2 gr per day plus furazolidone 400 mg per day for a week, and famotidine 40 mg per day for four weeks. Group II received just famotidine 40 mg per day for six weeks. At the initial endoscopy,four biopsies were taken from the gastric antrum for histological study and determination of Helicobacter pylori. The endoscopy was repeated between 6 and 8 weeks after the beginning of the antibiotic treatment, when four biopsies were taken again from the gastric antrum with the same purpose, and the results were compared. Twenty-eight patients completed the study, 14 in group I and 14 in group II. Helicobacterpylori eradication was obtained in 85,7 per cent of patients in group I and 0 per cent in group II (p=0.00002). Ulcer cicatrization was obtained in 100 per cent of patients of group I comparedto 85,7per cent of patients of group II(p=0.48)...

Multi-drug resistant typhoid fever with diarrhea.

OBJECTIVE: To provide information about the characteristics of diarrheal stool in multi-drug resistant typhoid fever and observe the clinical course after treatment with furazolidone or ciprofloxacin. SETTING: Hospital based. SUBJECTS AND METHODS: Twenty one male children who were positive for multi-drug resistant S. typhi by blood and stool cultures, having diarrhea at the time of hospitalization comprised the subjects. Serum and stool electrolytes were estimated. Stool samples were also processed to detect established enteropathogens, leukocytes and red blood cells. Children were treated either with furazolidone or ciprofloxacin and evaluated till recovery. RESULTS: Mean (+/- SD) pre-admission duration of fever and diarrhea of these cases were 19.1 (+/- 5.6) and 15.8 (+/- 4.6) days, respectively. Stool character in 81% of the patients was watery with mean (+/- SD) volume of stool 51.4 (+/- 25.1) ml per kg body weight in the first 24 hours of observation. Leukocyte count varied between 20-49 per high power field in 66.7% stool samples. Occult blood was present in only 19% cases. Fecal red blood cells in high power field were detected in 52.4% cases. Mean fecal electrolytes (mmol/liter) were as follows: sodium-53.8, potassium-51.4, chloride-41.6 and total CO2-24.3. Most of the children (71.4%) had no dehydration and had normal serum electrolytes. The isolated strains of S. typhi were multi-drug resistant. These children were treated successfully either with furazolidone or ciprofloxacin. CONCLUSION: The stools of multi-drug resistant typhoid fever patients were watery with little blood. Their electrolyte contents were more similar to the diarrheal stool seen in shigellosis rather than cholera. Uncontrolled observations revealed that children recovered with furazolidone or ciprofloxacin therapy.

Ensaio terapêutico na infecção por Giardia muris em camundongo com metronidazole, tinidazole, secnidazole e furazolidone / A therapeutic trial in Giardia muris infection in the mouse with metronidazole, tinidazole, secnidazole and furazolidone

Foi testado in vivo a sensibilidade de Giardia muris a quatro drogas comumente usadas no tratamento da giardíase humana. Foram utilizados 7 grupos de animais, com 12 camundongos cada, sendo que o grupo controle recebeu apenas solução salina 0,15M (0,5ml/animal). Os demais grupos receberam em dose única: metronidazole e furazolidone (500mg/kg), tinidazole e secnidazole (200mg/kg). A eficácia das drogas foi avaliada através da contagem de cistos nas fezes e pela ausência de trofozoítos no intestino. O metronidazole foi a droga mais eficaz. Os cortes histológicos mostraram diferenças entre o padrão da mucosa intestinal de animais normais e parasitados. No entanto, não se observou diferença entre o padrão de mucosa de animais infectados tratados e não tratados, o que sugere que estas alterações podem ser causadas pelo parasito e não pelas drogas.

A comparative study about the effectiveness of metronidazole, tinidazole, secnidazole and furazolidone was performed on Giardia muris from mice naturally infected. Groups of 12 animals each was constituted: the control treated with saline; one treated with metronidazole; one treated with furazolidone; one treated with tinidazole; one treated with secnidazole; histological normal control; histological infected. Samples of three stools were examined before and after treatment with quantification of cysts. Animals were cured when the trophozoites was not seen in the small bowel. The curative activity of drugs was 58.3% for metronidazole, 50% for furazolidone, 40% for secnidazole and 16% for tinidazole. It was also showed that there was a different pattern of the intestinal mucosa from the control and infected groups, treated or not, suggesting that the alterations encountered in the mucosa of infected animals were due to the parasitism either the action of the drugs.

Five day and ten day triple therapy (amoxacillin, furazolidone and metronidazole) in the treatment of duodenal ulcer

Essa investigaçäo teve o intuito de comparar em pacientes portadores de ulcera duodenal ativa e Hp+ a erradicaçäo da bactéria e a cicatrizaçäo com a associaçäo de Furazolidona 600mg/dia + Metronidazol 750mg/dia + Amoxilina1, 5mg/dia, quando administrados por 5 (TT5) ou 10 (TT 10) dias. Foram incluidos no estudo 54 pacientes (TT 5 = 28 e TT 10 + 26). Ao final da quarta semana, a cicatrizaçäo da ulcera foi constatada em 77,8 por cento no grupo TT e 5 e 75 por cento no grupo TT 10. A erradicaçäo da bactéria foi respectivamente de 51,9 por cento e 65 por cento (p>0,05). Nos pacientes com ulcera cicatrizada, observou-se que a cicatrizaçäo foi significativamente maior naqueles em que a bactéria foi erradicada. Concluimos que o prolongamento por dez dias nao influenciou significativamente nos resultados de cicatrizaçäo da ulcera e erradicaçäo do Helibacter pylori

Dispepsia no ulcerosa y Helicobacter Pylori: comparación del efecto de la asociación de Bismuto más Furazolidona Vs. Sucralfate

Se describen los resultados clínicos e histopatológicos de un grupo de pacientes con DNU, quienes consultaron únicamente por dolor de "tipo ulceroso" y fueron tratados con la asociación de subsalicilato de bismuto más furazolidona dirigido contra el Helicobacter Pylori (grupo I) o sucralfate, un conocido citoprotector de la mucosa gástrica (grupo II). Se encontró una mejoría significativa con los dos tipos de tratamiento, sinembargo, en el grupo que recibió el tratamiento dirigido a eliminar la colonización gástrica por Helicobacter Pylori, la mejoría histológica fue superior que la observada en el grupo tratado con sucralfate. La disminución de los cambios inflamatoria encontrada en el grupo de sucralfate podría estar relacionada con sus propiedades citoprotectoras y con la disminución de la adhesión del Helicobacter pylori a las células epiteliales del estómago. Los hallazgos sugieren que el Helicobacter pylori puede ser la causa de síntomas dispépticos y en un grupo adecuadamente seleccionado de pacientes con DNU, un tratamiento de erradicación mejora los síntomas

Bismuto más furazolidona Vs. Famotidina en el tratamiento de la gastritis erosiva crónica

Se estudiaron 42 pacientes con síntomas dispépticos con hallazgos endoscópicos sugestivos de gastritis erosiva crónica. La mitad fueron tratados con la asociación de bismuto más furazolidona y el resto con Famotidina. Se encontró mejoría endoscópica significativa con los dos tratamientos, pero la mejoría histológica fue mayor con el primer tratamiento, el cual se asoció a desaparición del Helicobacter pylori. Los resultados anteriores sugieren una etiología múltiple de los cambios observados en la mucosa gástrica en esta entidad

Comparative efficacy of furazolidone and nalidixic acid in the empirical treatment of acute invasive diarrhea: randomized clinical trial.

Efficacy of furazolidone and nalidixic acid was compared in a randomized trial involving 72 children with acute invasive diarrhea. Thirty six children received furazolidone (7.5 mg/kg/day) and 36 children received nalidixic acid (55 mg/kg/day). Clinical characteristics of the two treatment groups were comparable on admission. Of these, 34 children in furazolidone treated group and 29 children in nalidixic acid treated group completed the full course of treatment and were analyzed finally for clinical efficacy. Clinical cure was observed in 29(85.3%) children treated with furazolidone and 29(100.0%) children treated with nalidixic acid. Nalidixic acid treated group had statistically significantly higher cure rate (p = 0.039) as compared to furazolidone treated group. However, 85% cure rate in furazolidone treated group may be potentially useful for the treatment of acute invasive diarrhea because of decreasing efficacy of nalidixic acid against shigellosis in many countries.