A randomized, multicenter and noninferiority study of amoxicillin plus berberine vs tetracycline plus furazolidone in quadruple therapy for Helicobacter pylori rescue treatment.

OBJECTIVE: Helicobacter pylori (H. pylori) infection is closely associated with gastric ulcers and gastric adenocarcinomas. We aimed to assess the efficacy and safety of a quadruple regimen with amoxicillin plus berberine vs tetracycline plus furazolidone in rescue therapy for H. pylori eradication. METHODS: We conducted a randomized, open-label, multicenter, noninferiority trial. Patients with previous treatment failures recruited from five centers were randomized (1:1) to receive a regimen with esomeprazole and bismuth plus either berberine and amoxicillin (the BA group) or tetracycline and furazolidone (the TF group) for 14 days. Their H. pylori infection status was confirmed 4-8 weeks after treatment. The primary outcome was the eradication rate. The secondary outcomes included the rates of symptom improvement, compliance, and adverse events. This study was registered at ClinicalTrials.gov (NCT03609892). RESULTS: Altogether 658 participants were consecutively enrolled. An intention-to-treat analysis demonstrated that the two regimens achieved a similar eradication rate (76.3% vs 77.5%; P = 0.781). The per-protocol analysis reached a similar result (81.5% vs 85.0%; P = 0.278). The eradication rate reached in the BA group was greater than the pre-established margin of noninferiority, at -10% (the lower bounds of the 95% CI were -7.66% and -9.43%, respectively). The rate of adverse events was lower for the BA group than the TF group (18.5% vs 26.1%, P = 0.024). Rates of compliance and symptom improvement were similar for the two therapies. CONCLUSION: The efficacy of both regimens in rescue treatment for H. pylori eradication was satisfactory, 14-day BA-based quadruple therapy is noninferior to the TF-based therapy.

Comparison of Ciprofloxacin-Based Triple Therapy with Conventional Triple Regimen for Helicobacter pylori Eradication in Children.

Helicobacter pylori infection is a prevalent disease among Iranian children. The purpose of this study was to compare the effect of ciprofloxacin and furazolidone on eradicating helicobacter pylori in Iranian children in combination with amoxicillin and omeprazole. In this cohort study, helicobacter pylori infection was confirmed by gastroscopy, rapid urease test or pathologic assessments. A total of 66 children were randomly enrolled; based on the random number table, and were divided into two groups; first, a combination regimen consisting of ciprofloxacin, amoxicillin, and omeprazole; second, a three-medication regimen consisting of amoxicillin, furazolidone, and omeprazole. The effect of both medical regimens on the successful eradication of helicobacter pylori infection was assessed and compared. Chi-square test was used for evaluating the association between quantitative variables. All comparisons were made at the significance of P<0.05. Endoscopic tests prior to initiating treatments showed that 66.7% of the patients had a degree of nodularity while peptic ulcer was only observed in one patient. One month after the end of the treatments, eradication of the helicobacter pylori infection was reported 87.9% (29/33) in the first group (CAO) and 60.6% (20.33) in the second group (FAO) (P=0.011). It appears that a major advantage of our proposed regimen over others is a lack of wide use of fluoroquinolones for treating children's diseases. Given FDA's recommendation about the possibility of prescribing ciprofloxacin for infected patients with multidrug resistance, we can use the regimen proposed in this study in patients with resistance to standard treatments.

Therapeutic evaluation of free and liposome-loaded furazolidone in experimental visceral leishmaniasis.

Drug delivery systems are promising pharmaceutical formulations used to improve the therapeutic index of drugs. In this study, we developed a liposomal formulation of furazolidone that targets Leishmania (Leishmania) chagasi amastigotes in a hamster model. Using laser scanning confocal microscopy, it was demonstrated that the liposomal drug co-localised with L. (L.) chagasi amastigotes within macrophages. Liposomal furazolidone administered intraperitoneally at 0.5mg/kg for 12 consecutive days reduced spleen (74%) and liver (32%) parasite burden at a 100-fold lower dose than the free drug. Free furazolidone (50mg/kg) also effectively reduced spleen (82.5%) and liver (85%) parasites; its in vitro activity against promastigotes and intracellular amastigotes demonstrated a high degree of parasite selectivity. Thus, furazolidone, both in the free and liposome-loaded formulation, is an effective inhibitor of L. (L.) chagasi, representing a possible cost-effective drug candidate for the treatment of visceral leishmaniasis.

Pharmaceutical agents known to produce disulfiram-like reaction: effects on hepatic ethanol metabolism and brain monoamines.

Several pharmaceutical agents produce ethanol intolerance, which is often depicted as disulfiram-like reaction. As in the case with disulfiram, the underlying mechanism is believed to be the accumulation of acetaldehyde in the blood, due to inhibition of the hepatic aldehyde dehydrogenases. In the present study, chloramphenicol, furazolidone, metronidazole, and quinacrine, which are reported to produce a disulfiram-like reaction, as well as disulfiram, were administered to Wistar rats and the hepatic activities of alcohol and aldehyde dehydrogenases (1A1 and 2) were determined. The expression of aldehyde dehydrogenase 2 was further assessed by Western blot analysis, while the levels of brain monoamines were also analyzed. Finally, blood acetaldehyde was evaluated after ethanol administration in rats pretreated with disulfiram, chloramphenicol, or quinacrine. The activity of aldehyde dehydrogenase 2 was inhibited by disulfiram, chloramphenicol, and furazolidone, but not by metronidazole or quinacrine. In addition, although well known for metronidazole, quinacrine also did not increase blood acetaldehyde after ethanol administration. The protein expression of aldehyde dehydrogenase 2 was not affected at all. Interestingly, all substances used, except disulfiram, increased the levels of brain serotonin. According to our findings, metronidazole and quinacrine do not produce a typical disulfiram-like reaction, because they do not inhibit hepatic aldehyde dehydrogenase nor increase blood acetaldehyde. Moreover, all tested agents share the common property to enhance brain serotonin, whereas a respective effect of ethanol is well established. Therefore, the ethanol intolerance produced by these agents, either aldehyde dehydrogenase is inhibited or not, could be the result of a "toxic serotonin syndrome," as in the case of the concomitant use of serotonin-active medications.

One-week omeprazole, furazolidone and amoxicillin rescue therapy after failure of Helicobacter pylori eradication with standard triple therapies.

AIM: To test the efficacy of omeprazole, furazolidone and amoxicillin triple therapy for the treatment of Helicobacter pylori infection after failure of standard first-line therapy recommended by the Asia-Pacific Consensus on the management of H. pylori infection. METHODS: Patients with failed H. pylori eradication received omeprazole, 20 mg, furazolidone, 100 mg, and amoxicillin, 1 g, all twice daily for 1 week. Endoscopy (CLO test, histology and culture) was performed before treatment. Post-treatment H. pylori status was determined by 13C-urea breath test 6 weeks later. RESULTS: Fifty patients were recruited. Resistance to metronidazole, clarithromycin and both drugs was in the range of 50-64%, 60-75% and 40-50%, respectively, after failure of first-line therapy. Amoxicillin resistance was not found. The intention-to-treat and per protocol H. pylori eradication rates were 52% and 53%, respectively. Patients with double resistance to metronidazole and clarithromycin showed the lowest eradication rate (38%), which was significantly lower than that of patients with sensitive strains (88%). Side-effects were minimal and compliance was excellent (98%). CONCLUSIONS: One-week omeprazole, furazolidone and amoxicillin rescue therapy achieved a high eradication rate in strains sensitive to metronidazole and clarithromycin. This is a cheap and safe rescue regimen when guided by pre-treatment sensitivity testing.

Evaluation of different antibiotics in inhibiting colonization of Vibrio cholerae O1 and O139 in the rabbit intestine.

The effects of furazolidone, erythromycin and azithromycin in inhibiting colonisation of Vibrio cholerae O1 and O139 in the rabbit intestine were tested. Both V. cholerae O1 and O139 highly colonised the gut in control rabbits. The colonisation of furazolidone-resistant strains in the rabbit intestine was prevented effectively by both erythromycin and azithromycin. In furazolidone-sensitive strains, the efficacies of erythromycin and azithromycin were very much comparable to furazolidone. These results suggested that azithromycin may be subjected to clinical trial in comparison to furazolidone and erythromycin for the treatment of cholera due to O1 and O139 infection in children.

[Clinical observation on verrucous gastritis with combined therapy of traditional Chinese and Western medicine].

Controlled study of verrucous gastritis treated with combined therapy of TCM-WM was compared with that of WM only. The result showed that the total effective rate and the cured rate of former were 97.83% and 84.78%, while that of latter were 77.14% and 22.86% respectively. The TCM-WM revealed better results than WM alone. Follow-up was done after six months, the recurrence rates of the two groups were 9.10% (2/22) and 43.75% (7/16) respectively, the difference was significant (P < 0.05). There was no side effect in combined therapy and the therapy was convenient for use.

[Use of the leaves of the dandelion (Taraxacum officinale L.) in the feeding of the silkworm Bombyx mori L]. / Otglezhdane na koprinenata buba Bombyx mori L s lista ot glukharche (Taraxacum officinale L.).

Experiments were carried out with eggs of Bombyx mori of the J--124xC--122 hybrid, imported from Japan. Tested was the feeding of the silkworm moth on leaves of dandelion (Taraxacum officinale L.) up to the end of the III instar. Feeding was also carried out with dandelion leaves up to the end of the IV instar, which, immediately prior to offering to the moths were sprinkled with water solutions of flurazolidon, 1.5 per cent, chloramphenicol with propylen glycol (5%)--50 cm3 each/1 of water or nalidixic acid, 2.5 per cent. The effect was studied of the antibacterial preparations applied to every kind of feed on the amount of microflora in the alimentary tract. It was found that moths given dandelion leaves reached the III instar, however, there was a very early manifestation of spontaneous nuclear polyhedrosis and bacterial infections of the alimentary tract. The addition of antibacterial preparations reduced the outbreaks of the two diseases and the microflora in silkmoths. Discussed is the possibility of the wide use of broad-spectrum antibacterial drugs in the prevention of these diseases.

Comparison of vaccination and treatment in controlling naturally occurring infectious bovine keratoconjunctivitis.

A vaccination study for infectious bovine keratoconjunctivitis was conducted on 108 newborn Hereford calves in the US Department of Agriculture Meat Animal Research Center cattle herd at Clay Center, Nebraska. Groups were allocated so that age of calf, sex of calf, and age of dam were equally distributed between the 54 vaccinated (group I) and the 54 nonvaccinated (group 2) control calves. The dams of both groups of calves were monitored as group 3 controls. An autogenous Moraxella bovis bacterin (formalin-killed, whole cells) was given IM at birth and at approximate intervals of 2 weeks for a total of 3 doses. Bacterial isolation rates for the cattle in groups 1, 2, and 3 during the summer were 92.6%, 92.6%, and 54.1%, respectively, and disease rates were 100%, 96.3%, and 70.6%. The rates were significantly (P less than 0.05) different between calves and cows. Vaccination of calves at birth permitted serum antibodies to develop before the calves were extensively exposed to infection; however, immunity to the disease did not develop. In a treatment study of other animals in the same herd, but in another pasture, the same criteria were used for allocation of 107 cow-calf pairs. Eye spray was applied to treated principals (group 4, 52 calves; and group 6, 53 cows) each week after examination and sample collection. Controls consisted of 54 calves (group 5) and 54 cows (group 7) that were examined and cultured bacteriologically in the same manner. The bacterial isolation and disease rates were less (P less than 0.05) in the treated calves (group 4) than in the nontreated controls (group 5). The differences in bacterial isolation rates between groups 6 and 7 were not significant, but group 6 had less (P less than 0.05) grade III lesions than did group 7. Weekly treatment appeared to be more effective in reducing the incidence of disease than did vaccination.