Furazolidone and Helicobacter pylori Treatment

We read with great interest the article published by Hosseini et al.1 in October issue of Middle East Journal of Digestive Diseases. Briefly, in this article, authors concluded that furazolidone based therapeutic regimens (in moderate and even high-dose) were not preferable for first-line treatment against H.pylori infection among the northern population in Iran.1 Altogether, some points we found may not support their final conclusion. 1Standard triple therapy is a known formulation for H.pylori treatment; however, recent recommendations are indicating unacceptable eradication rates, mostly because of emergence of clarithromycin resistance. As an alternative, authors chose furazolidone and amoxicillin with different dose (high and moderate) as new therapeutic regimen. As such, furazolidone use; especially in shorter duration (7 days) could be attractive for clinicians. Major critic to authors’ conclusion is lack of knowledge about antibiotic resistance of H.pylori. In other words, authors have no data about antibiotic resistance of amoxicillin and furazolidone among H.pylori strains isolated from patients in north of Iran. Thus, combined therapeutic regimens consist of these drugs could not represent an appropriate treatment. 2Rapid increasing prevalence of antibiotic resistance has called an urgent request to reconsider the established H.pylori therapeutic regimens and rethink about newer ones.2 However, in developed countries the use of furazolidone is highly prohibited due to the its carcinogenic effects.3,4 Unfortunately, the relatively low cost of this antibiotic led to its frequent use in developing countries such as Iran. Taking together, it seems that using this antibiotic should not be replaced in common drugs in H.pylori first line therapy. In fact, antibiotic regimens for H.pylori eradication need to be reconsider before prescribing in clinical practice in area with data from antibiotic susceptibility patterns.